I was just reading through a recent Guardian newspaper piece in relation to anxiety. The paper took a novel approach. Instead of the hordes of experts that we are more used to reading on all matters ‘mental health’ related, the editors opted here to let people who suffer from bouts of overwhelming anxiety have their say. That’s an approach to the subject which is bound to grab the attention of any psychoanalyst worth her salt. What the sufferer has to say is really the only place from which to start any treatment.
What will immediately strike you if you give the article even a most cursory glance will be the extent to which the people speaking of their experiences are drawn to talk about the degree to which anxiety is experienced in the body, and how utterly disrupting and disturbing that is for sufferers. Paul, for example, describes how it shows itself to him as a whole gamut of distressing physical symptoms, up to a pressure in the body which he feels in his chest, making him feel he’s about to have a heart attack. Elizabeth speaks of physical symptoms coming on without warning so that in the past she might have thought that she had some undiagnosed life-threatening illness, such as a brain tumor. Jake experienced a kind of detachment from his own bodily being, alongside tingling in the hands and feet. Colin’s extreme panic meant he felt himself always to be either on the verge of death or in need of the bathroom (and quick!).
The less obvious point that is consistently made by the contributors relates to the ‘mind-body’ divide. So we’re left with the following: Is it all in my head? In which case, why is it so obviously all in the body? The pure weight of physical symptoms tends to focus the mind in that direction and so the GP is usually the very first port of call. In such circumstances it can be hard at times for the GP to get the patient to accept that another sort of help is needed, even if medication can relieve overwhelming disruptive symptoms. In the newspaper piece, Tiffany, who also talks about her physical symptoms, puts it well when she says that even though it’s a myth to talk of it being all in one’s head, it’s at the very least mostly mind-related. It put a virtual stop to her life for quite a while before she realised it was mainly a psychological issue. “The mind controls the body and vice versa”. Accepting this is a pathway to looking at other ways to approach treatment. And besides there’s heaps of research out there now in support of the notion that psychotherapy, the Talking Cure, has a great part to play in that.
So the psychoanalytic approach to such cases is to begin (just as for the article) from the patient’s words. The suffering body arrives, with its palpitations and chest pains, shortness of breath and tightness in the throat, nausea, stomach-ache and diarrhea, headaches, tingling hands and feet. However, very shortly the life story begins to reveal itself. It’s not to say that a very traumatic life event is always there to be identified as the culprit driving the anxiety-machine. 18 year-old Salma states that for us clearly enough. More usually the person has no idea about what the driver is and no thoughts can be identified as accompanying the onset. That doesn’t mean that there is no story behind it though. Unconscious positions and ideas can have all their effects without reaching consciousness at all and it’s the therapist’s job to enable that stream of ideational material to unfold. In this way the unwinding narrative takes up a new relation to the body and with time and patience anxiety dissipates somewhat or even entirely. We discover a way to bind it differently.
So, it’s not all ‘just in your head’ … but then that doesn’t mean it’s just all in the bodily symptoms either!
And No! It doesn’t all disappear like magic to the sound of the pearls of wisdom dropping from the therapists’ mouth. And it doesn’t go away overnight. The pattern of physiological responses will not disappear as soon as the talking starts. But it’s one hell of a great start to the journey when the sufferer’s story rises up as a calmative to the pain of the symptom.
The article “How Not To Talk To Someone With Anxiety” is well worth a careful read. It appeared around the 20th of this month as part of the paper’s contribution to the U.K.’s Mental Health Awareness Week. Nothing very different in it from our Irish experience. Nothing, that is, unless if you count the size of the budget for (even if that is diminishing) and the availability of publicly funded psychotherapy services (Blessed NHS?) if you just so happen to be a sufferer.
And what is it that one doesn’t say to someone with anxiety? The usual rubbish. Think positive. Pull yourself together. Oh, I get that too … You’ll be ok in a minute!
[If you are suffering with anxiety you could contact your GP and/or call us here at Prospect Psychotherapy Practice. Our practice is situated at 16 Prospect Road, in Glasnevin, Dublin 9]