For me, 2004 was marked by a constellation of new experiences. Some were pleasant; others were not. I’d started my first year at university, which was a relief after 13 years of single-sex schooling. Social jockeying, coded girl-speak, an obsession with spray tans and netball: I was not made for that milieu. Instead, I pinned my happiness on university, where liberation was to take place. Indoor pursuits would triumph. And so I spent most of my time angling for new-found social prominence at campus cafes, conspicuously leafing through the Economist in an attempt to not only signal the seriousness of my academic intent, but also to win friends. (It turns out this was an ill-conceived strategy.)
That year was also the first time I started experiencing regular panic attacks. First of all, it is important to note that everyone experiences panic attacks differently. For me, it feels like my body is temporarily undergoing an intense internal contraction – much like a damp rag being wrung out. The onset is sudden but the duration is brief: an episode is usually over in 10 minutes.
The first attack is the hardest as there is no precedent, but you become familiar with each repeat occurrence: everyone has unique, telltale signs. Once I felt my hands become clammy, I soon learned that chest tightness and heart palpitations would follow within a matter of minutes. (It is also not uncommon for people to have an impending fear of death during an episode, or to feel dissociated from the brief paralysis of body and mind.)
After the first few attacks, my obsession quickly evolved from a fear of dying to maintaining a quiet dignity lest I was spotted in public. No mean feat when you’re hyperventilating.
What I didn’t know was that these episodes would strike indiscriminately: in the library, in the Botanic Gardens, in department store fitting rooms. The unpredictability means you learn to leave the house prepared: I made notes to memorise breathing techniques, and always kept a couple of alprazolam tabs in my purse. For extra security, I’d re-route my journeys from destination A to B so to avoid (a) people I knew; (b) people I didn’t know; and (c) the temptation to shop on impulse, depending on my mood. I vowed not to be caught out.
The process of diagnosing and treating anxiety disorders often resembles a scientific experiment. Your doctor will seek out the controlled variables (Are you on the pill? Are you in a stable relationship? Is there a genetic predisposition to mental illness?), and tweak the independent (How anxious are you on a daily basis?) and dependent variables (How can we use medication/therapy to reduce your anxiety?) accordingly. My GP at the time, a man in his early 30s with a permanently upturned mouth, rattled off the conditions listed on the Diagnostic and Statistical Manual of Mental Disorders (DSM-V-TR), occasionally adding an upwards inflection that imitated a personalised consultation process, rather than a routine medical procedure.
‘But how do you make the distinction between “normal” anxiety and the type that requires medication?’ I asked.
‘Instinct,’ he said. ‘Just see how it goes. If it doesn’t work, we’ll try something different.’
But as the DSM definition of generalised anxiety disorder demonstrates, the benchmarks are vague:
A. Excessive anxiety and worry (apprehensive expectation), occurring more-days-than-not for at least 6 months, about a number of events or activities (such as work or school performance).
B. The person finds it difficult to control the worry.
C. The anxiety and worry are associated with three (or more) of the following 6 symptoms (with at least some symptoms present for more-days-than-not for the past 6 months):
- restlessness or feeling keyed up or on edge
- being easily fatigued
- difficulty concentrating or mind going blank
- muscle tension
- sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep).
D. The focus of the anxiety and worry is not confined to features of other Axis I disorder (such as social phobia, OCD, PTSD etc).
E. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
F. The disturbance is not due to the direct physiological effects of a substance (e.g. a drug of abuse, a medication) or a general medical condition (e.g. hyperthyroidism), and does not occur exclusively during a mood disorder, psychotic disorder, or a pervasive developmental disorder.
What would a first-year Arts student know about the ontology of mental illness, anyway? ‘Probably more than you’d think,’ my doctor said, as if he’d heard the question countless times before. I’d gone there, after all, with the purpose of resolving physical symptoms that were becoming a noticeable impediment. ‘So you see,’ he said, ‘how instinct works both ways.’
I left the doctor’s office that day with a prescription for paroxetine and a mental-health plan that outlined – in a series of austere dot points – the pathways for treatment. Seeing the symptoms in writing, however, made me uneasy. For years I had assumed that they were merely a syndrome of characteristics associated with my personality; a predisposition rather than a problem that needed treatment.
The bugbear I harboured about the diagnosis lingered for some time. My family, with whom I have a pleasant but not overly emotional relationship, defined by meticulous self-concealment, were never informed. It took a few years – by which time the panic had resurfaced, and I had accumulated a better set of friends – before I told anyone. Their reaction, extraordinary in its empathy, included the revelation of many of their own experiences with mental-health specialists, particularly in their late teens/early twenties. If nothing else, the revelation quickened the emotional-bonding process by tenfold.
These feelings – the perceived disintegration of self- control, the daily accumulation of oft-disabling neuroses – weren’t out of the ordinary, but an unspoken affinity that provided, at least for me, more reassurance than chemical treatment or cognitive behavioural therapy.
Statistics from beyondblue, an Australian not-for-profit organisation that aims to increase awareness of depression, anxiety and related illnesses, suggest that anxiety disorders are among the most common of mental disorders in Australia. Nearly one in seven people will experience some form of anxiety disorder in any one year, although it is more common in women (one in six) than men (one in 10). More significantly, one quarter of the population will experience an anxiety disorder during the course of their lives.
On reflection, the preponderance of anxiety-related issues among my friends wasn’t so unexpected. At 18 we were nominal adults at best (at least, I certainly was), greeting life with an irrational exuberance that was negated by our own navigational laziness. Why bother going to the trouble of figuring things out when you could crowd-source solutions through a blog?
University-educated, middle-class, socially estranged and always underpaid: it’s a familiar narrative. We had, back then, an inexplicable fondness for Reality Bites and perhaps were eager to frame our experiences accordingly. But maybe our expectations were misaligned. Maybe too much time was exhausted on cultivating what we thought were charming collegiate affectations: unwittingly acquiring a wardrobe that resembled the senile grandmother’s from The Nanny; casually dropping certain social theorists in everyday conversation (Žižek, always; Marx, never); or being able to articulate, with utmost precision, the exact ironic distance one should keep from any chosen subject.
These affectations signalled a salutary desire for self- improvement, but it was also the narcissism of these small differences that would dignify our mediocre existences from those of the other directionless losers. On meeting these parameters, my friends and I weren’t afraid of failing, as much as we were embarrassed about being seen not to reach our potential. Our anxieties were a vast cloak for our aspirations.
The prescription of selective serotonin re-uptake inhibitors (SSRIs, which are used as antidepressants) and concomitant psychological therapy is the preferred treatment for anxiety disorders in Australia. According to the Australia Institute’s most recent biennial Health and Welfare report card, released in 2010, there were 12.3 million scripts written for antidepressants in 2009. Moreover, during the past 12 years – since the data was first collected – prescription rates for antidepressants have risen by 46 per cent.
SSRIs take a couple of weeks to take effect, and can initially cause more anxiety as the body undergoes corrective adjustments. I was initially turned off by the slow onset. Lexapro, Luvox, Prozac, Zoloft, Aropax, Effexor – the recitation of these brand names is enough to induce somnolence. Nausea, dry mouth, weight gain and a low sex drive are the most common side-effects of antidepressants, and certain effects are more pronounced in some brands than others.
Zoloft made my weight balloon, while Aropax made me wade through a dense brain fog on a daily basis. My short- term memory – normally a dependable asset – began to atrophy in a matter of weeks. I eventually settled on Lexapro, which was remarkably effective as a mood stabiliser. So effective, in fact, that I felt I was on emotional autopilot: no feeling was too extreme, and no need for excessive scrutiny of internal monologues. For people who find it difficult to regulate their emotions – and who possess the discipline to take a pill each day for six months to a year – medications like these can be a godsend. That said, it is hard to assess their efficacy in treating anxiety, just as it is hard to make definitive judgments about cognitive behavioural therapy. Finding a treatment that works can be a game of trial and error, and much scientific literature and anecdotal evidence serves to reiterate this point.
I was struck, however, by how different the medical treatment of anxiety is in the US. That nation remains gripped by what psychiatrist Gerald Klerman called ‘pharmacological Calvinism’ – a phrase coined in 1972 to describe the nation’s love–hate affair with Big Pharma. The most commonly prescribed drug is Xanax (generic name: alprazolam) and its ritzier sibling, Xanax XR. Xanax stays in the body for 11.2 hours, compared with Valium’s 200 hours – it is often seen as an instant form of relief that, if used responsibly, has minimal impact on the body. In 2010, more than 50 million US prescriptions were written for Xanax, slotting it ahead of sleeping pill Ambien (known as Stilnox in Australia) and antidepressant Lexapro. Conversely, Australian doctors are reluctant to hand out benzodiazepines because of the high risk of addiction and abuse, and as such they tend only to be doled out for the short-term relief of panic disorder. But for those without addictive personalities, benzodiazepines can bridge the widening gap between the complexity of modern life and one’s capacity to cope with it.
If nothing else, the relief lies in silencing the mental noise that so often disorients you from the real world. For me, medication was a way of neutering my emotional reactions to conditions that were liable to change without notice. This is important, considering an anxious person will spend most of their time cross-checking and indexing real-time developments against idealised outcomes. It’s exhausting even before you reach the part where you have to recalibrate your expectations and adjust emotionally. Factor in the multitude of stimuli – media detritus, constant notifications and an information overload – and your brain starts to resemble a Facebook news feed: it is impossible to discern a linear narrative amid the junk.
Sometimes I think the internet has a similar effect to benzodiazepines. While benzodiazepines induce the dissolution of all peripheral distraction to achieve a state of hermetic thoughtlessness, the internet wreaks a cacophony of stimuli that leads to that same, indivisible null. No matter the path you choose, the result is the same: you are opting out of a certain type of living. In The Feminine Mystique, Betty Friedan hints at this desire to strip away one’s consciousness: ‘You wake up in the morning and you feel as if there’s no point in going on another day like this. So you take a tranquilizer because it makes you not care so much that it’s pointless.’ As someone who considered myself to be critical rather than cynical, the fact that I felt liberated by this dopey resignation was disconcerting.
It’s been a few years since my last panic attack – they tend to come in waves, before receding again for months at a time – and I have been off antidepressants for some years. Anxiety is no longer the crippling force that it once was, but a disproportionate fear over the uncertain still lingers. It has evolved into something banal and quotidian.
In a recent article on the popularity of Xanax in New York magazine, Lisa Miller argued that anxiety has a ‘second life as a more general mindset and cultural stance, one defined by an obsession with an uncertain future’. She also argues that depression neatly encapsulated the psyche and affect of the 1990s: collective stomachs yearned for Prozac, reflecting the sort of social disconnectedness and aimlessness that can only flourish amid untrammelled economic prosperity. That’s not to diminish the harrowing effects of clinical depression – that was not Miller’s intention – but to illustrate a profound cultural shift. These trends do not exist in a vacuum, after all – Elizabeth Wurzel’s autobiography Prozac Nation, Richard Linklater’s Slacker, grunge – they all rebelled against society’s narrow definition of success. As Miller notes: ‘Depression as a cultural pose work[ed] only in tandem with a private confidence that the grown-ups in charge are reliably succeeding on everyone’s behalf.’
By 2008, however, those so-called grown-ups in charge had failed us. The global financial crisis has revealed, quite spectacularly, the true extent of one’s powerlessness. In times of crisis, which is more frightening: the idea of collective deterioration or the effect on the individual? When Miller writes of anxiety as a ‘cultural stance’, she suggests that it can only coexist in an increasingly chaotic and uncertain climate. Self-preservation kicks in: How will I deal with this? What will happen to me?
Situational or otherwise, anxious people respond to circumstances beyond their control by way of an unmitigated freak-out. Anxiety is also, for some, a form of self-predication. A friend of mine – a journalist who is seeing a psychoanalyst for her anxiety – asked me whether we’d chosen the wrong jobs for our predispositions. ‘Perhaps we’re in the wrong industry,’ she said. I protested that I liked my job. ‘What else could we be doing?’ Sure enough, five minutes later – after we’d compiled a list of the people we knew in the industry – we arrived at the conclusion that most people we knew in high-pressure jobs were, for whatever reason, highly strung, perennially anxious types. They were simply more adept at dealing with; some even depended on it to get things done. Living on the psychological edge can be its own adrenaline rush.
As early as 1920, Hungarian psychiatrist Thomas Szasz remarked that ‘the greatest analgesic, soporific, stimulant, tranquilizer, narcotic and, to some extent, even antibiotic – in short, the closest thing to a genuine panacea – known to medical science is work.’ It’s an interesting view, this idea of anxiety as a form of self-affirmation; in the same way that one proclaims to be an introvert, a vegan or a libertarian. In this sense, we begin to see the ontological difference between a benign kind of anxiety and the sort that is a fully fledged, debilitating disorder.
The anxiety never completely subsides, not least because the persistence of memory is the reminder you never ask for. It comes and goes as it pleases, with the volatility of a casual lover. Sometimes, when I feel a pang of nostalgia for my undergraduate years, I stalk the halls and grounds of my alma mater. As I sit in the bowels of the university library some eight years later, watching Melbourne’s impetuous weather act as a convenient metaphor, I realise that all you can do is patiently wait for stillness.