Diagnosis
I was formally diagnosed with generalized anxiety disorder, but I don’t think that encompasses the whole of my mental health issues. Playing self-diagnosis for a minute, I have also had agoraphobia, panic disorder and, maybe less severely, OCD, depression and social anxiety disorder.
It feels like there are a mix of mental health tendencies that are activated to different degrees at different times. I have always been aware of the tendencies, but they became a life-limiting problem in 2008.
Medication
I was prescribed Citalopram for a brief period, which is an SSRI. It was, in my experience, disastrous. Even when given several weeks to take effect, it actually made the anxiety worse, and introduced a much more severe depression where I felt the closest to suicidal I have ever felt.
“It actually made the anxiety worse.”
Its side effects were part of what made me more anxious. There were many, but I remember one in particular. Every now and then, my perception of the position of my head would feel wrong: it would feel like my head was about two inches to the right of where it really was, before the perception would unpleasantly ’snap’ back into place.
Of course, different people can respond wildly differently to the exact same medication. This is just one experience on one extreme of the scale!
I have been without medication for five years now.
Challenges
Five years ago, I was starting university. I was struggling with a number of issues before I began, having faced a disintegration of a fledgling social life after unsuccessfully trying to support friends who were in emotionally abusive relationships. It wasn’t the most stable start, you could say.
University didn’t go well. I was socially rejected, not by everyone, but by the people with whom I had to live in close proximity. This was in part because I wasn’t able to feel confident about being myself, perhaps because of the experiences leading up to the start of university. Not feeling safe or relaxed when ‘at home’ in halls of residence, I began to build up a debt of coping capacity.
The result of this build-up of stress with no relaxation was my first panic attack, in a lecture theater. Unfortunately, things got worse from there, despite moving halls of residence, the medication and other strategies.
By the middle of my first year at university, I had exhausted all options for strategies to cope and my course was deferred, and then eventually abandoned entirely.
The initial panic attack spawned many others, and it soon became impossible to do anything without the panic, or the fear of panic, being overwhelming. Everyday tasks like grocery shopping, going to any kind of event outside my home, were, at the worst points, impossible.
“At the worst points, I literally could not have imagined being able to go into work each day and being able to cope.”
Over the last five years, these issues have improved immeasurably. As the issues improved and I worked with my strategies, I was able to start doing volunteering for just a couple of hours a week, which was initially exhausting. Over time, though, the hours built up, volunteering became paid employment and I am now doing a job (that does involve leaving the house!) for four days a week.
At the worst points, I literally could not have imagined being able to go into work each day and being able to cope. Things got so much better.
Now, from a work point of view, my anxiety sometimes pops up, threatening to make me panic when I get into work, or making doing something unusual in an unusual place, such as going on a training course, a lot more challenging and tiring than most people would expect. Overall, though, my strategies are effective and I can operate at work without it being life-limiting, and without others noticing.
Outside of employment, there are parts of my life still held back by the legacy of these issues, as well as the activation of other mental health tendencies I haven’t fully tackled yet. Now that I am successfully back to work, I have big plans to address these other aspects of my life!
Strategies
Cognitive behavioural therapy, or CBT, is the big buzzword of the moment, especially in health systems that have become reluctant to immediately medicate, like the UK’s National Health Service.
Some would describe the techniques and strategies I have developed as CBT. I don’t know if I would, but that’s how I brand it if I need to write my ‘treatment’ on a form. How I have approached this feels custom, proprietary, and not at all like a treatment ‘product’. Perhaps some other people would find these ideas helpful, but some people probably really wouldn’t!
To begin, a willingness to expose myself to risk was necessary. Risk and perceived risk might as well be the same thing inside your head, so it doesn’t matter that the risk is irrational, or non-existent outside my ‘world’. It is real, for the purposes of this discussion, so you treat it with respect, grant it some legitimacy, and prepare yourself to take calculated risks.
“A willingness to expose myself to risk was necessary.”
I needed to meet myself where I was, not where I wanted to be, or where my peers were. I was fortunate to have access to a wonderful psychologist who introduced me to this. My frame of reference for what success is and what failure is has to take account of what is difficult for me today, not what others would intuitively assume is difficult, or what I eventually want to find difficult. If going for a 10-minute walk around the neighborhood is a success for today, then it is a success. It really helps if you have someone else supportive with this pragmatic mindset to meet with regularly: they can spot successes and that helps you realize the progress you are making.
“If going for a 10-minute walk around the neighborhood is a success for today, then it is a success.”
I needed to feel ownership over the process of tackling my anxiety. Having others to support was vital, but I had to feel in control of the process I was following, especially when I didn’t feel in control of anything else in my life.
I require anxious thoughts, and negative thoughts in general, to be auditioned inside my own head before they are granted legitimacy. I force these thoughts to justify themselves—“OK, I’ll give you that, if you can explain it to me rationally”. I have found that the lower intensity anxieties can be bluffed into non-existence in this way. I have to do this credibly: if I lose the ‘argument’ with the thought, then I don’t fight it further in that way. As soon as that system feels like it’s difficult to trust and difficult to believe, then the anxiety can bypass it. On good days, this is effective for 90-95% of the thoughts that might crop up.
In other cases, I’ll be consumed with a fear already and it will have taken hold. It has the stage, and fighting it head on will lead to an increase in its intensity and a resulting panic. In these instances, I try to accept its existence in my head at that time. We’re firefighting something big now, so my goal will be stability and damage limitation rather than ‘winning’. I will avoid external stimulation, try and take some time out of the situation in a private place, and try to ‘slow’ the thought process. This is a lot easier said than done. In some cases, you can’t get out or away, so I’ll just close my eyes, try to stay still and allow the fear to rule, with the knowledge that it will eventually run out of energy.
“My goal will be stability and damage limitation rather than ‘winning’.”
I also have developed, over time, a self-knowledge of the early warning signals. Getting to know the process of how the anxiety operates arms you with foreknowledge so you can take avoidance and mitigation measures early. This was a difficult part of the process, because my anxiety became ‘aware’ of my monitoring its signals, so it then could manufacture early warning signs so I would respond, and then I would avoid doing things. So, over-reliance on this doesn’t work, and it is necessary for me to make sure I regularly push myself over those boundaries to counter this, and to re-assess where the ‘real’ boundaries now are.
I have put in an enormous amount of hard work, and been very courageous to get to where I now am, but I think part of my recovery was actually out of my control. A part of it was that I got better because my brain recalibrated itself. I say this not to suggest that failing to do this work would have resulted in my recovery anyway—it wouldn’t have—but to make the point that not everything was, or is, under my control.
So, I have a toolbox of tactics that is always evolving as my anxiety’s tactics do. Every time I ‘won’, it evolved and attacked me in a different way. Eventually, it ran out of novel tactics that were extremely effective. The battle goes on today, with the opportunistic activation of my various mental health tendencies, but I have now restricted it to not being life-limiting in terms of doing my work. The anxiety is a whimper rather than the deafening roar of the worst points of my life, but with a few areas of particular strength I’m going to battle it on yet.