Trigger warnings: anxiety, depression, suicide
There’s a reason two of the most common things I hear are “You worry too much” or “Just stop worrying about that.” There is a deep level of ignorance in this society regarding mental illness. I would love to be asked “Why do you worry about that?” or “Are you able to stop worrying about that?” instead, but until people learn more about anxiety or any other mental illness, they will never understand what kind of questions to ask or things to say. I don’t believe most people are ignorant because they choose to be ignorant – the problem is a direct result of stigma, shame, and people being afraid to be open about their struggles because they will be… [insert whatever appropriate word here: bullied, not accepted, labeled, shunned, embarrassed, etc.].
So how do we fix this ignorance dilemma? In my mind, the answer is simple – if not easy – because it starts by looking in the mirror. Sometimes I doubt the fact that the world can start to change with just one person, but in this case, I think it’s true. If I do what I can to educate myself and a few others, then if each person I reach out to works to educate themselves and a few others, we have a ripple effect that might change the world as we know it. So what do you think? Do you want to change the world with me?
“We all experience emotional ups and downs from time to time caused by events in our lives. Mental health conditions go beyond these emotional reactions and become something longer lasting. They are medical conditions that cause changes in how we think and feel and in our mood. They are not the result of personal weakness, lack of character or poor upbringing” (NAMI, Learn More, 2018).
I absolutely love the above statement from the National Alliance on Mental Illness (NAMI). It does an amazing job of succinctly stating not only what mental illness is (a medical condition), but also what it is not (weakness, cries for attention, or the result of being a bad person). The stigma, and subsequent deep-seated shame, come as a result of people clinging to incorrect ideas of mental illness.
For me in particular, I have the exhausting combination of Generalized Anxiety Disorder (GAD), Social Anxiety Disorder, and Depression. I once had a primary physician (yes, a medical doctor) tell me that anxiety and depression are the same thing and should be viewed and treated as interchangeable. Ummmmm…no. Anyone who thinks anxiety and depression are the same has obviously never experienced either. It is frustrating when even medical professionals don’t take it seriously or don’t even try to understand the difference. What makes this scenario even worse is that this is someone who was prescribing a psychiatric medication. How could they possibly be trusted to know what or how much to prescribe when they don’t even acknowledge the difference between illnesses? There’s a reason I don’t have my PCP manage psych meds anymore! This is an example of why it is critical to find a good psychiatrist for medication management and/or a good therapist for behavioral therapy or psychotherapy – not all medical professionals are created equal when it comes to psychiatric care.
Every person’s story is unique. Every person’s experience with mental illness is different. In order to hopefully shed some light on and reduce ignorance about mental illness, I want to share a little more about my own demons. Please remember that my story is just one of thousands. My experience with a specific disorder may be completely different than someone else’s. It’s dangerous to generalize when it comes to mental health – each illness is so incredibly specific to each individual. Please keep that in mind as you continue reading.
Generalized Anxiety Disorder
What is it?
According to the Mayo Clinic, Generalized Anxiety Disorder is characterized by “excessive, ongoing anxiety and worry that are difficult to control and interfere with day-to-day activities” (Mayo Clinic Staff, 2017). A more detailed list of symptoms include “persistent worrying or anxiety about a number of areas that are out of proportion to the impact of the events; overthinking plans and solutions to all possible worst-case outcomes; perceiving situations and events as threatening, even when they aren’t; difficulty handling uncertainty; indecisiveness and fear of making the wrong decision; inability to set aside or let go of a worry; inability to relax, feeling restless, and feeling keyed up or on edge; and difficulty concentrating, or feeling that your mind ‘goes blank’” (Mayo Clinic Staff, Generalized Anxiety Disorder, 2017). I have yet to see a more accurate list of mental and emotional symptoms. This doesn’t even include the physical symptoms one might experience on a day-to-day basis.
What causes it?
If I asked some Joe Schmoe off the street what causes an anxiety disorder, he might say, “It’s caused by someone worrying too much.” I use this example because that is what I have gotten time and time again from people who know me, yet don’t want to take the time to understand me. It is unfortunately not so simple – oh, how I wish it was…it would be easier to “get over it” if it was! Instead, it is caused by “a complex interaction of biological and environmental factors, which may include differences in brain chemistry and function, genetics, differences in the way threats are perceived, and development and personality” (Mayo Clinic Staff, 2017). As much as people don’t want to admit it, anxiety can (and often does) have a biological source. In fact, more than one part of the brain can play a role in anxiety disorders (NIMH, 2016). Although overthinking and worrying are symptoms of anxiety, they are not the cause or sole factor.
Social Anxiety Disorder
What is it?
NAMI defines Social Anxiety Disorder in the following way: “More than shyness, this disorder causes intense fear about social interaction, often driven by irrational worries about humiliation (e.g. saying something stupid or not knowing what to say). Someone with social anxiety disorder may not take part in conversations, contribute to class discussions or offer their ideas, and may become isolated. Panic attacks are a common reaction to anticipated or forced social interaction.” (NAMI, Anxiety Disorders, 2017).
Speaking from my own experience, what seems to be irrational to other people is extremely debilitating. I went to therapy for several months to try and prepare myself for my own wedding because I was so terrified of all the social interactions and expectations. I often lay awake at night thinking about my various social interactions throughout the day, wondering if people think less of me because of how or why I said something. I hyper analyze every aspect of my behavior before, during, and after social situations. It is not uncommon for me to ruminate over other possible responses months or even years after the fact. I acknowledge that I likely invent perceptions that others have of me, which in turn influence how I perceive myself. I allow these perceived opinions of me to directly influence my own self-worth and self-confidence. At times, it makes it impossible for me to participate or even attend social gatherings. When I do attend social events, you will most likely find me sitting in a corner by myself observing the other event goers, hoping no one feels the need to come keep me company, yet wishing desperately for someone to rescue me from my misery. It’s really quite awful. If you have someone in your life with social anxiety, I would highly recommend sitting down with them and having a heart to heart conversation about ways in which you can help them manage their anxiety and even ease some of their suffering while in the midst of social interaction.
What causes it?
As with GAD and most other mental illnesses, there are many different factors that come together to cause Social Anxiety Disorder. Genetics and brain structure play a big part. According to the Mayo Clinic, “people who have an overactive amygdala may have a heightened fear response, causing increased anxiety in social situations” (Mayo Clinic Staff, Social Anxiety Disorder, 2017). The theory of nature versus nurture plays a big role with Social Anxiety Disorder sufferers. We may have been classically conditioned to exhibit a fear response due to some bad experiences in the past, but there also “may be an association between social anxiety disorder and parents who either model anxious behavior in social situations or are more controlling or overprotective of their children” (Mayo Clinic Staff, Social Anxiety Disorder, 2017).
I find the last one factor incredibly interesting, especially in my case. Anxiety does run in my family, but I was also homeschooled from kindergarten all the way through high school. Whether we like to admit it or not, homeschoolers have a pretty bad reputation for being socially challenged at best. This stems from having little to no social interaction beyond that of our siblings and parents. Some homeschoolers are more involved with extracurricular activities than others. In my case, we really only had social interactions outside of the home when we would attend church functions. I would argue that this kind of protective environment can backfire because a lack of social interaction comes with the heavy cost of non-existent coping mechanisms for awkward or uncomfortable social situations. Although I have been told that I don’t come across as the stereotypical homeschooler and that I seem to do okay with social interaction, the turmoil going on under the surface in indescribable. You may not see the anxiety, but oh is it there. It makes me wonder if greater social interactions growing up would have aided in development of appropriate social coping mechanisms.
Note: I know my mom reads this blog, so I’ll make a note here that I don’t blame my parents for my struggles with mental health. It is no more their fault than mine. It is no one’s fault! Although environment plays a key role in cognitive development, I believe I have a genetic predisposition. I am who I am for a reason and no one should be blamed for the good, the bad, or the ugly!
What is it?
The Mayo Clinic describes depression as “a mood disorder that causes a persistent feeling of sadness and loss of interest… it affects how you feel, think and behave and can lead to a variety of emotional and physical problems. You may have trouble doing normal day-to-day activities, and sometimes you may feel as if life isn’t worth living” (Mayo Clinic Staff, 2018). If you take nothing away from this, take away the fact that depression is more than just feeling sad that your favorite TV show was just cancelled or that you went for ice cream and they were out of your favorite flavor. Depression is a life altering, sometimes life ending, illness. It is serious.
Speaking from recent experience, depression can be both devastating and terrifying for both the sufferer and their loved ones. I personally live several hundred miles from my immediate family and from my very best friend, so they felt helpless to do anything while I tried to deal with significant depression and even suicidal ideation. What made the biggest difference in attempting to pull myself out of my depression were three things:
- Emotional support system: Although my immediate family and best friend do not live in the same state as me, I have identified several key players in my local support system. I opened up to them about the ugliness going on in my life. Making others aware of what you are going through can be the game changer you need. It is a way to hold yourself accountable to seek help and treatment. It also provides an outlet when you need to talk out some feelings, as well as someone to reach out to when you are in over your head. I also adopted a dog, who provides companionship and a level of emotional therapy I never imagined possible.
- Medication management: I recognized that I was in trouble and scheduled an appointment with my psychiatrist. We have been working diligently to adjust and modify my medication regimen to enable greater success in my recovery.
- Therapy: I am realizing that I can only process so much on my own or with the help of friends. Considering what I have been through the last few years and how volatile my emotional and mental states have been, I am finally realizing that I need to get a professional involved in helping me process everything correctly and in a productive manner. Hopefully some hard work with my new therapist will help me avoid future run ins with depression.
What causes it?
NAMI states that “depression does not have a single cause. It can be triggered by a life crisis, physical illness or something else – but it can also occur spontaneously” (NAMI, Depression, 2017). Emotional, mental, and physical trauma can be a major player in depression. Losing a loved one, going through a divorce, or experiencing abuse can really change the way we view ourselves, expect to be loved, or even love ourselves.
Physiological causes of depression seem to be better understood than the causes for the two anxiety disorders I discuss above. NAMI explains that “the frontal lobe of the brain becomes less active when a person is depressed. Depression is also associated with changes in how the pituitary gland and hypothalamus respond to hormone stimulation” (NAMI, Depression, 2017). These are some crucial bits of brain anatomy being mentioned.
- Frontal Lobe: “Carries out higher mental processes such as thinking, decision making, and planning” (brainmadesimple.com, Frontal Lobe, n.d.).
- Pituitary Gland: “It’s main function is to secrete hormones into your bloodstream” and one symptom of pituitary gland issues is “changes in psychological state, including mood swings or depression” (Seladi-Schulman, 2018).
- Hypothalamus: “Controls the pituitary” and “influences the functions of temperature regulation, food intake, thirst and water intake, sleep and wake patterns, emotional behavior and memory” (Pituitary Foundation, 2018).
I mean, holy moly. If you look at just those three things, not to mention environmental stressors and traumatic life events, see what functions are influenced? My psychiatrist told me recently to “not make any big decisions while you are depressed because you are not thinking rationally.” I can see why! Think about that small list of brain anatomy next time you are tempted to think that depression is simply someone being sad, lazy, or “just” emotional.
Now….take all three of those and put them together!
“Having anxiety and depression is like being scared and tired at the same time. It’s the fear of failure, but no urge to be productive. It’s wanting friends, but hating socializing. It’s wanting to be alone, but not wanting to be lonely. It’s feeling everything at once, then feeling paralyzingly numb.” – Unknown
There are so many other mental illnesses and so many stories that are similar and vastly different to my own. I hope sharing a combination of objective facts and subjective experiences can help others understand a little bit more of what I and countless others go through on a daily basis. And I hope that having the courage to open up and be vulnerable about my own experiences inspires some others to open up about theirs. Yes, stigma exists, but it should not. So many of us suffer from mental illness. Let’s join together and fight this fight proudly. We are all survivors! As a dear friend of mine reminds me continually, “You have survived 100% of your days up to this point. You will survive today as well.” (love you, Steph!)
Come on…let’s be the ripple that causes a tsunami of understanding.
Brainmadesimple.com. (n.d.). Frontal Lobe. Retrieved from http://brainmadesimple.com/frontal-lobe.html
Mayo Clinic Staff. (2018). Depression. Retrieved from https://www.mayoclinic.org/diseases-conditions/depression/symptoms-causes/syc-20356007
Mayo Clinic Staff. (2017). Generalized Anxiety Disorder. Retrieved from https://www.mayoclinic.org/diseases-conditions/generalized-anxiety-disorder/symptoms-causes/syc-20360803
Mayo Clinic Staff. (2017). Social Anxiety Disorder. Retrieved from https://www.mayoclinic.org/diseases-conditions/social-anxiety-disorder/symptoms-causes/syc-20353561
NAMI. (2017). Anxiety Disorders. Retrieved from https://www.nami.org/Learn-More/Mental-Health-Conditions/Anxiety-Disorders
NAMI. (2017). Depression. Retrieved from https://www.nami.org/Learn-More/Mental-Health-Conditions/Depression
NAMI. (2018). Learn More. Retrieved from https://www.nami.org/Learn-More
NIMH. (2016). Generalized Anxiety Disorder: When worry gets out of Control. National Institute of Mental Health. Retrieved from https://www.nimh.nih.gov/health/publications/generalized-anxiety-disorder-gad/index.shtml
Pituitary Foundation. (2018). What is the pituitary gland? Retrieved from https://www.pituitary.org.uk/information/what-is-the-pituitary-gland/
Seladi-Schulman, Jill. (2018). Pituitary Gland Overview. Retrieved from https://www.healthline.com/human-body-maps/pituitary-gland