An age of anxiety
Anxiety is central to the human condition, essential to our survival as a species, troubling in the extreme when out of hand. It is certainly the most difficult of my own emotional states to contain and I know, from my professional experience, how much misery can be caused by anxiety related conditions.
Anxiety is, at one level, an immensely protective instinct. It is the reflex that helps respond to external threats and anticipate future dangers. For anxiety is more than fear, more than the immediate reaction to danger. It encapsulates our ability to contemplate future events, to spot distant threats and to take anticipatory action to avoid them. A little anxiety in the right places goes a long way to help us survive and prosper, both as individuals and as a species. The origins of many disasters lie in complacency, in too great a sense of security, not in anxiety.
But anxiety can get out of hand and become a major source of distress. Anxiety disorders including panic attacks, generalised anxiety disorders and post-traumatic stress disorders are calculated to have a lifetime prevalence of as much as 15% with 10% affected at any given time. This makes anxiety the most common source of mental distress, including amongst children and young people. The conditions appear more common in developed countries and amongst women. Anxiety based symptoms are also often central to the experience of many people with psychotic illnesses.
Like depression, anxiety conditions, suffer from a stereotype of being moral failings rather than genuine illnesses. The reality is that, while for many of us anxiety is a passing state, for others, especially where their anxiety condition is linked to some major trauma in their life, the symptoms of anxiety have a significant and unmanageable impact on their ability to function and their quality of life. Anxiety can also fuel destructive habits of self-medication through alcohol and drug misuse.
Also like depression a significant majority (between 50 and 60%) of people with anxiety disorders receive no treatment despite exhibiting symptoms above clinical thresholds for care. For those who do receive treatment, choice is often limited, with a major focus on medication. The introduction of the Improving Access to Psychological Therapies programme in this country has improved access to Cognitive Behavioural Therapy, a very valid intervention for many affected by anxiety disorders, but representing but the tip of the iceberg in addressing the unmet need for greater access to talking therapies. As I have argued many times before in this blog it would be a national outrage if the NHS were to only offer chemotherapy for cancer patients and yet such a position is still accepted for one of the most common and devastating set of mental illnesses.
As well as affecting individuals anxiety disorders manifest themselves at a societal level. There is no doubt that we live in an age of anxiety. Constant change, economic uncertainty, the disappearance of old norms and certainties fuel our collective sense of doubt and anxiety about the future. Our media, now penetrating virtually every moment of our waking lives, operates in the currency of anxiety. As we can see happening across the world, it is to the advantage of certain political leaders, as it was in other eras, to encourage our sense of anxiety and, in particular, to channel that deep seated anxiety about “others” which goes back to our days as isolated hunter gatherer groups.
So as well focusing on a serious attempt to broaden access to treatment for those who are affected by anxiety disorders we need to think about how we manage our collective anxiety. The decline of religion in the west has removed some of the traditional responses to this and has left a void in terms of philosophical and practical approaches to dealing with the anxiety of our age. Agnostic in my own beliefs I am not seeking to defend traditional religion but rather to highlight the place it took in helping managing our anxieties as individuals and a society.
These are not new problems. Ancient philosophers such as Epicurus (totally falsely connected with notions of gluttony and good living) were equally concerned with how we might control our sense of anxiety and reach a sense of calm or “ataraxia”. The consolation of philosophy is much needed in the modern world and some of the thinking of the ancients, who did not believe, like us, that every human problem could be solved by technology is very much worth revisiting. Similarly techniques such as mindfulness which help us to detach ourselves from and control better the impact of our anxieties are valuable things to encourage and disseminate both in schools and for adults.
Whatever response we take, we should recognise anxiety as great a public health challenge as is obesity and that indeed many of the physical health challenges we face are deeply connected with issues of psychological distress and insecurity. I had been encouraged, a couple of years ago, by the emergence of interest public mental health. It is crucial that, despite denuded budgets, public health practitioners and policy makers continue to recognise the importance of psychological resilience. There is indeed no health without mental health and nothing will better illustrate that than how we respond to the growing threat of anxiety in our society.