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Archive for the ‘anxiety’ Category

In the last couple of generations, modern industrial culture has seriously reduced the range of acceptable emotions. Certain emotions are not only unpleasant, the conventional wisdom goes, but should be avoided at all costs. However, the older I grow, the more I become convinced that this attitude is not only wrong, but actively harmful.

One of the most obvious examples of this attitude is the insistence on extroversion. Today, the model of the well-adjusted person has become an outgoing optimist who lives and works in groups, and feels uncomfortable alone. Not only are projects in schools and businesses increasingly done in teams, but even yoga and meditation, originally intended for private reflection, is done primarily in groups. By contrast, anyone with a preference for occasional privacy is seen as maladjusted at best, and at worst a potential perpetrator of another campus shooting.

This either-or distinction is a distortion of Carl Jung’s original concept, which described two poles of behavior, and was never intended to label people. Nor did Jung intend to condemn either extreme. Equating introversion with maladjustment is as accurate as it would be to condemn extroverts for being irresponsible and unable to focus; both extremes might include such behaviors, but actually cover a far broader ranger of behavior.

More importantly, as Anthony Storr points out in Solitude, many forms of creativity and original thought seem to require extended periods of introverted behavior. For that matter, the most successful forms of collaboration tend to be like the one used in free software, in which people work alone in the initial stages of their works, then collaborate for peer review and tweaking. By devaluing introversion, we are probably also undermining creativity – which may explain why movies with three or more names on the script rarely produce anything memorable.

Similarly, certain states of mind, such as depression and anger, are seen not only to be unpleasant, but to be avoided and medicated as quickly as possible. More – any decisions or conclusions reached in these undesirable states are questioned, or excused as being the indication of an unsound mind.

In some cases, that might be so. But always? Probably not. Depression and anger are natural reactions to events like the death of someone close, or being treated unfairly.. While dwelling endlessly on such things is unhealthy, accepting them for a certain amount of time is probably necessary for coming to terms with them. Denying this need, or trying to shorten the time in which such emotions are indulged may be as mentally unhealthy as removing a cast before a bone has had time to knit back together is unhealthy physically.

As for these emotions offering a skewed version of reality, why do we assume that the optimism that we believe is typical of a well-adjusted person is any more accurate of a perception? Personally, I have seen more projects – and companies – spiral downward because of decisions made by an optimist who was unable to admit when something was going wrong. A depressed person might at least anticipate problems so they could be countered, or admit problems when actually faced with them. In the same way, an angry person might drive themselves harder for success. Instead of accepting only one attitude as realistic, I suspect that we need to accept a much wider range of emotions as sometimes offering useful perceptions.

Yet another example is the nervousness and anxiety typical of someone who moves into a new job or set of responsibilities. When you stop to think (and even when you don’t), there are valid reasons for feeling uneasy. There are many things you can’t know about your new position, and you want to prove yourself to colleagues and ultimately become a success.

Many athletes and performers recognize such feelings – actors call them “flop sweat.” But rather than pretending that these feelings don’t exist, they worry when that not having such feelings will lead to a flat and uninspired performance. The trick, they will tell you, is to control these feelings, to channel them into the performance. If you can do that, you will have the extra edge that leads to outstanding performance.

However, we don’t admit that flop sweat is natural, let alone teach people how to cope with it. Instead, we give it a name like Impostor Syndrome, elevating it to a psychiatric condition – which except in a small minority of cases, it usually is not – giving the sufferers one more thing to worry about and elevating the feelings into some vast, impersonal force. Instead of teaching them how to reduce the anxiety by practice or planning, we encourage the sufferers to give themselves affirmations, or seek the approval of others. We encourage them to look for placebos rather than solutions that are known to work, and, as we do so, we are probably both preventing the development of competence and encouraging mediocrity.

I am not the sort of Puritan who believes that suffering is necessary for success, or needs to be sought out. But I do believe that it must be confronted directly, not avoided. Too often, in our panic to avoid the least unpleasantness, we limit ourselves and short-circuit the processes that are necessary for accomplishment and competence. We mean well, but in enforcing extroversion and pleasantness, we may also be suppressing necessary and useful emotions.

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A close acquaintance of mine has had post-traumatic stress syndrome (PTSD) for the better part of a decade. Recently, this person referred to their condition to a relative, only to receive the reply, “Aren’t you over that yet?”

The response highlights one of the many misunderstandings of this condition. In fact, from its origins to its symptoms, treatment, and long term prospects, probably no other mental condition is so misunderstood. Nor is understanding encouraged by the fact that the words “trauma” and “stress” are bandied about by people to refer to normal reactions to daily events or merely mild upsets.

So what is PTSD? Contrary to popular perceptions, it is almost never the anxiety caused by financial or romantic concerns, or by grief. All these circumstances can be stressful, but do not result in PTSD unless other factors are at play as well.

Nor is PTSD simply a reaction to physical trauma, such as combat or rape. Many people go through both and do not develop PTSD, while some people develop it because of psychological sufferings, such as interactions with unsympathetic authorities or the suicide or random deaths of people around them.

Just as importantly, there is no way of predicting what will cause PTSD. What triggers the condition in one person may seem trivial to another, and some cases of PTSD are caused by a single episode while others are caused by a continuing sequence of events. Contrary to the way that “shell-shock” was once regarded, it is not a matter of cowardice, but of being overwhelmed and rendered powerless by events.

Similarly, while some studies suggest a genetic predisposition to PTSD, what matters is whether a person ever encounters circumstances that will cause the condition in them.

Another reason to downplay any genetic tendency is that the cause of PTSD seems primarily psychological. What all cases of PTSD seem to have in common is a loss of world-view – in particular, an individuals’ ability to control their own life.

Faced with a loss of meaning and control, those with PTSD develop what psychologists refer to as “hypervigilance” — a more or less continual condition of extreme alertness. This condition generally includes permanent physiological changes to the body, including an exaggerated startle response, and permanently higher pulse rates, and higher blood pressure. A PTSD sufferer is always far closer to fight or flight than the average person, or than what they were when they were healthy.

These physiological changes explain the images of PTSD in popular culture, in which the crazed war veteran goes berserk, or the badly stressed resort to alcoholism or drug addiction. And, in fact, sometimes those with PTSD do act in this way. However, more common symptoms are depression, loss of purpose and direction, nightmares, and a distancing from social contacts. Perhaps the most common symptom is a sense of existential angst (in fact, it may not be a coincidence that existentialist philosophy emerged out of France around the end of World War 2).

All of these symptoms may be reinforced by a person’s reluctance to disclose their problem for fear of appearing vulnerable – after all, to the hypervigilant, to appear weak means that they are risking attack.

Contrary to the response my friend received, PTSD is not something you “get over.” It makes permanent changes to the body, and probably the mind as well. It can flare up at any time, even after many years. In this respect, PTSD is similar to malaria – it is something that you learn to live with, but never move beyond.

Treatment of PTSD is two-fold. In the short term, those who suffer from it can minimize its effects by reducing the stress in their lives. Eating a balanced diet, staying physically fit, and getting rest all help. Even more importantly, those with PTSD need to develop a routine that minimizes the stress in their lives. They may need to find less stressful work, or have more flexible hours, or even work from home.

For example, the poet and novelist Robert Graves, who suffered shell-shock in World War I, eventually fled to the quiet of Majorca after over a decade of unsettled life in England. When people congratulated him on his apparent recovery, he explained that all he had done was to organize his life to deal with his problems.

In the longer term, the most successful coping mechanism seems to be to find a way to reaffirm the world view and values that PTSD have shattered. A classic example is the Canadian general Romeo D’Allaire, who suffered PTSD from what he perceived as his failure to do his duty as a soldier and stop the genocide in Ruanda while he commanded United Nation forces there. After a period of adjustment in which he was often drunk, D’Allaire managed to re-assert his ethics by becoming a strong advocate for peacekeeping by both Canada and the United Nations. He has also spoken frequently about PTSD and become something of an advocate for Canadian soldiers who suffer from his condition.

This sort of compensation can mean that, despite their condition, many people with PTSD can lead highly purposeful and accomplished lives. The catch is that they generally have to continue their accomplishments in order to reassert their world view against the trauma that has physically and mentally transformed them.

Finally, perhaps the most important point to make is that PTSD is not a mental illness in the sense that schizophrenia is. Instead, it is more accurate to compare it to an injury such as breaking a leg that permanently changes regular functioning. A person with PTSD is sane by any legal or common sense definition, but, like someone in whom an injury has left one leg shorter than the other, they have some troubles with ordinary functioning.

The next time you see someone with PTSD, try to keep these points in mind. And remember – the only reason that you haven’t suffered from the same condition may be that you have been lucky.

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