9.30 Anxiety - Cure For

Physician's Notebooks 9 - http://physiciansnotebook.blogspot.com - See Homepage
Updated 17 Septr 2021.
30. Anxiety   The descending column is main headings in order as each appears in text. (Also read the following chapter, Paranoia”)

Anxiety is?

Psychological Denial

Psychological Defenses Against Anxiety will Shape Personality

Obsessive Anxiety

The preventive of severe anxiety neurosis

Medication

For fictional account of psychosurgery for anxiety cure

Anxiety is? universal; everyone I've ever known has felt it every day of his or her life. Forget about dictionary definitions! Think about what you feel with any anxiety; what you may have felt a minute ago with that brief pain in your chest or your hip or wherever; or the anxiety you may have felt when yesterday you got that letter from the IRS about your tax return (or lack of it) or any worry about anything in your life. At its core, anxiety is a feeling, more or less, of unease that something bad will befall one, or that one may fail to get something one wants much. At times it is a fear that one’s body's feeling or blood test result may mean one is going to die in greater pain or distress, sooner than later. I could go on and on about specific anxieties we all feel but I think the point is made.  It’s adaptive and normal; without it our ancestors would mostly be dead from predators or accidents. (and we too). 

 

The more anxiety one has, the less happy one is. And it distracts one from attending to important matters and causes one to behave inappropriately and interferes with cognitive skills like memory.

In excess and at times for reasons in particular individuals, in particular situations and at particular times of life, anxiety may overflow into acute attacks (Panic with attacks.) Also Agoraphobia (Fear of being in open places). Public Speaking, or Social Anxiety Disorder (SAD) or specific phobia, or may become a high chronic state of worry unhappiness (GAD). In particular forms, anxiety may show as paranoia (See next chapter), insomnia, depression, or other bad personality problem and it may deform a character. Here I want to give advice how to minimize anxiety, how to deal with acute situations; essentially, all as part of a good psychoanalysis. 

Psychological Denial: “All humans die. I am a human,” you can repeat to yourself without affect on sleep, sex life, appetite, even though those words mean you must die in a foreseeable future.  That is an example of one important defense against anxiety: psychological denial of a fact that if emotionally accepted would cripple you. But if you are a physician, as I am, and accidentally prick yourself with a needle with which you just drew blood from an HIV-positive AIDS patient, you will not be able to sleep, sex, eat, enjoy life well, until your own HIV test stays negative 3 to 12 months later. This is an example of reality’s breaking down one's psychological defenses and causing acute anxiety. Someone I know has known of having leukemia for 20 years and has come close to death twice from it, yet still lives a constructive life denying the reality that would make most other persons in his same position nervous wrecks. This is to show the power and usefulness of psychological denial when it can be maintained. Yes, in many cases this denial will crumble as the reality of one's human condition pokes holes in it. But that should not cause us to disrespect its power and usefulness in particular persons and situations.  Although psychological denial is undoubtedly useful in keeping a person calm and effective in the face of bad knowledge, it is basically an unstable reaction because eventually it must crumble. Ideally, it is better to face a bad fact by saying "I have a deadly illness." and take a win-win approach ("I'll try to win by curing my illness" or "Everyone I know dies of something they do not know about yet, so I win by knowing about my something and thus being able to live creatively with the knowledge of how I may die.")  And in the last case it becomes a constructive life-enhancing challenge to live creatively. But that which is ideal is not always practical so a therapist (or a friend) should not quickly attempt to face a person in denial with facts that will destroy that useful defense unless it is part of a well thought-out psychoanalysis.

Psychological Defenses Against Anxiety will Shape Personality One's personality can be the result of lifetime defenses to prevent anxiety. Thus, a personality or behavior pattern may be interpreted as reaction against the reality (or belief) of its opposite. One who is obsessively clean is reacting to anxiety generated by the belief he is becoming a dirty mess and it soon will show. One who engages in extremes of physical exercise is reacting to worry of weakening. (Cf. 1942 The Pride of the Yankees movie showing Lou Gehrig over-training himself because he is first noticing the weakness of the disease that will kill him.) And someone who studies crazily for no obvious reason is doing it in reaction to a feeling of weakening in brain power. This understanding is useful to the analyst. But needs to be with care interpreted to a patient in order to prevent paranoid reaction by the patient's coming to think the doctor is not taking his worrisome behavior seriously. It helps the doctor in his attempt to maneuver the patient's understanding. Also not infrequently it turns out the patient is wrong about his internal belief and if that can be shown objectively severe anxiety may be relieved. (The CBT, Aaron Beck, approach.) This is one example of the tools of cognitive behavioral treatment psychoanalysis in dealing with anxiety. It can be applied to everyday life as well as in treating mental illness. 

Obsessive Anxiety comes from neglecting to do a thing well and worrying compulsively you will suffer from the not-having-done-it-well effect. When carried to extreme, it becomes the mental illness of uncontrollably repetitive thought of regret that disturbs the sufferer for weeks and occurs in perfectionist type person. For example, I was intent on re-establishing my medical practice in New York State and it required I send application. I mailed the application by airmail and, having received no response after 2 weeks, I began to be mentally tortured by the repetitive thought that my letter got lost because of my using simple airmail. I suffered one week, making expensive telephone calls from Japan to Albany N.Y.; then decided to send a copy of the letter by registered airmail express. Soon as I posted the letter, my anxiety ended and I rested easy for the first time in days. Or other example: I decided to reward my daughter for achieving her M.B.A. so I sent her an unregistered letter with $5,000-check and for several days was unhappy worrying: Is the check lost and misused? Prevent these anxieties by doing things not in a way that will create a paranoia anxiety: it means, think ahead of your action and do it most safely. E.g., send the check registered mail and postdate it a week after expected delivery so that if it seems to have gotten lost you will have time to put a telephone stop on the check; and do not forget to make a copy of the check you sent so that you will have the check number without which you cannot stop a check. But keep in mind stopping a check involves a penalty of up to $35. At extremes this becomes obsessive compulsive disorder OCD that is very hard to satisfy.

If you do an action and get anxious, do a direct act that reverses the action. This can be generalized to many situations where you identify an act you consider a mistake that you could have prevented by more care: like neglecting to make an important offer in a sales proposal; like using or not using a word in proposing to or propositioning a yearned-for lover. It should be included in psychiatric remedies. A personal example occurred when I, as an 82-year-old physician had a work relationship with a 21-year-old woman. It badly disturbed the relationship that I found myself literally being almost tortured by the repetitive desire summed up in Why don't I proposition her sexually? Seeking to tryst with her I arranged a work session in a nearby hotel in a luxury room with double bed. During our 1-hour work session I could not summon up the nerve to make the proposition and I even felt like to grope at her but intelligently resisted the urge. Minutes after she left I said to myself "I must end this." and grabbed my mobile phone and texted her "Please come back. I need to have sex with you." She immediately texted back "No!" For several weeks afterward she refused to communicate with me but eventually we again developed our work relationship and from then I found I was freed up from the incessant almost compulsive anxiety that had forced me to proposition her after the said hotel meeting. By expressing my compulsive desire clearly and cleanly I had cured myself of the anxious obsession that had tortured me but I almost lost an important work relationship. The lesson here is when you feel a bad compulsion exorcise it by expressing it to the person involved, but quickly, sincerely apologize if what you expressed might be shockingly insulting

 The  lifetime preventive of severe anxiety neurosis is a secure loving childhood with two understanding and kind parents and one or only a few moves for changing living places. Experiments with maternal behavior show that a mother who spends loving moments each time she feeds her infant, gets the result of an infant without neurotic anxieties while a mother who feeds her infant without loving behavior (mechanically, carelessly) produces a highly neurotic offspring. This is useful as part of maternal or parental education.  Firstly, discussions between therapist and patient of the exact anxiety. If it is a single thing, a program of gradual exposure under controlled, safety will work after several sessions. For more complex anxiety like SAD (Social Anxiety Disorder like speaking in public) a gradual building up of the patient’s self-esteem with exposure to brief speakings before several persons works.   GAD or general panic attacks involve teaching the patient daily taking his own BP and HR and demonstrating how harmless the usual data are. Similarly with respiratory rate in hyperventilation. All of this: explanation and gradual exposure almost always convinces anxiety patients to ignore the usual anxiety effect and react normally.　

Medication: Of course, most persons know that tranquilizers are medication for anxiety. First came the bromides and the barbiturates and more recently the benzodiazepines. These all briefly relieve the anxiety state but I do not favor the usual tranquilizer because it is, essentially, a dulling sleep medication, with unpleasant disinhibition and short term absent-minded forgetting effects. My experience has been strong and positive with the tricyclic mood elevating medications, specifically Imipramine (Tofranil) 25 mg, a max of once every other day.  (I found in my own case that I am very sensitive to the good effects of Tofranil and that more than 25 mg every 48 hours induces tolerance to the good effects.)  It gives a pleasant non anxiety mood within the hour and lasting c. 12 hours and allows easy falling asleep. I occasionally use it when I really need a good day. But the use of medication for acute anxiety relief should not substitute for psychotherapy by psychoanalysis or other tested method.  Of course in certain situations a tranquilizer may be useful (Xanax pill 15 minutes before a fear-of-flying boarding, as with Dick Cavett in May 1980). It will save your day at that moment but will not help prevention. A type of structured psychotherapy (cognitive behavioral therapy, or CBT) has been found to work best for removal of severe types of anxiety. Essentially it consists of the imagining the anxiety situation, noting its actual inability to cause the feared results (death, going crazy) and coming to dis-habituate from the severe anxiety reaction because you just don’t believe in it any more.

 

 

For fictional account of psychosurgery for anxiety cure, click

13.10 Neurosurgery

13.11 At the Operating Table

13.12 Operating on the Living Brain

13.13 The Experiment

and read at your leisure.
END OF CHAPTER. To read next click 9.31 Paranoias of Life Removed by Physician's No..