Why do we feel anxious?

When our brain perceives something as a threat, it leads to a fight or flight reaction, which can trigger anxiety. It is normal to feel a little anxious but if it hinders your everyday functioning, it can be treated using therapy and, in some cases, medication. Bengaluru-based psychotherapist Michelle Manasseh talks about anxiety.

• What is anxiety?
• What are the causes of anxiety?
• Does modern living make us anxious?
• What are the kinds of anxiety disorders?
• When is the right time to seek professional help?

There is so much happening around the world that can make us feel anxious. Reading the newspaper and a constant barrage of information that we come across everyday, thanks to social media and the Internet, can all be triggers. Anxiety is a normal and healthy response to what we see around us, any perceived fear, threat, or uncertainty. But sometimes anxiety can become severe and hinder our everyday functioning, these cases can be treated using therapy or in some cases, medication.

According to a study, published in The Lancet journal, in 2017, about 197 million people had mental disorders in India; including 45·7 million with depressive disorders and 44·9 million with anxiety disorders. It said that more women than men suffer from depression and anxiety disorders in India.

In another study conducted in Gujarat, on women aged 18-50 years of age, 35% showed high anxiety levels. Homemakers had 1.2 times higher anxiety and 1.3 times higher stress than working women.

Femoai spoke to Bengaluru-based psychotherapist and adjunct faculty at Christ University Michelle Manasseh about what causes anxiety, its symptoms, the most common types of anxiety disorders, and what is the right time to seek professional help. Edited excerpts:

What is anxiety?

It is pretty much everything that an individual is fearful of and a lot of times it is with regard to the future — the fear of what might happen or how things might turn out. It could be a fear of what you see around you, questioning the aspects of things around you. These could become paranoia; people can also experience anxiety over fear of judgement, what others think about you. It is fairly broad in that sense. One can also have social anxiety, one can have phobias, one can have anxiety over judgement, anxiety about the future, or from not feeling in control of things.

Those are also the kinds of anxieties that we are dealing with at this point (because of the coronavirus) – the fear of not knowing, of uncertainty, of what the future is going to look like. We are dealing with questions like: am I going to be okay? Are my family members or my friends going to fall sick? If that happens, what is going to happen as a result of that? How restricted or free is the future going to be? That’s the large amount of anxiety that we are struggling with at this point. That’s how I would define it, in a layman’s terms, right now.

Right now, for a lot of people anxiety is caused by the pandemic and the lockdown, but, in general, what are the principal causes of anxiety?

The causes can vary like it is with any other health issue, it is the same with mental health as well. To a large extent, a lot of times with a lot of people, it comes as a predisposition of sorts, it’s genetic. If you are coming from a strain of family members who have suffered anxiety or anxiety disorders then you have a higher tendency of getting it, genetically speaking. In other ways, it is a mix of nature and nurture. It depends on the kind of environment you are growing up in. If your family, if your parents or the people around you are anxiety-prone, or fear-prone, then you also have a tendency of conditioning. You observe things around you and you get conditioned to act in a similar way. Therefore, we react to different things that we see as a threat. In a neurological or biological sense, what happens with the brain is that whatever we view as a threat leads to a reaction of fight or flight. Depending on the perception of what I might see around me, and if I view it as a threatening situation, it will lead to me feeling anxious and therefore reacting. In terms of causes, it can be past experiences, it can be history, it can be because of things happening repeatedly in my life that can cause anxiety and that can cause me to be anxious and uncertain of my future.

Our way of living, especially in the cities, has changed dramatically over the last two decades, does modern living make us anxious?

We often get anxious and stressed if things don’t happen quickly. There is a need for instant gratification. If anything is delayed, there is a higher chance of an individual in our generation being anxious because of the level of impatience. The reason that happens is because we are so conditioned to everything happening quickly.

We often get anxious and stressed if things don’t happen quickly. There is a need for instant gratification. If anything is delayed, there is a higher chance of an individual in our generation being anxious because of the level of impatience.

The Internet is instant, food is instant, all of those things. It is also about how you perceive that delay. For example, what if I don’t get my food before my meeting? If I perceive it as something that is going to cause me discomfort, then it can immediately cause anxiety. There is also the aspect of the unknown — that I am not used to the situation, it’s something that I am not familiar with.

It also comes with expectations that the society has of us — you can’t do this, you have to perform this way, there is competition. To a large extent, our urban culture has really added to our anxiety levels. The pressure of performing, the pressure on kids performing well academically, for women to get married at a specific age, having children at a specific age or having to look a specific way, you are constantly being pushed to fit a framework. If you don’t do it, you start feeling pressure and again feeling not good enough, and that can cause anxiety.

The pressure of performing, the pressure of kids performing well academically, for women to get married at a specific age, having children at a specific age or having to look a specific way, you are constantly being pushed to fit a framework. If you don’t do it, you start feeling pressure and again feeling not good enough, and that can cause anxiety.

The day and age we live in is significantly different from that of our parents, or even ten year ago. Women’s expectations are very different now. Women are also significantly more career driven, there are also more opportunities to allow for that. The structure has changed, but simultaneously, are we changing as a society? A lot of times I question whether we really are. As a culture we are still struggling with evolving, we are so stuck with our old expectations, we want everything else to evolve but our expectations from women seem to still be stuck 20 or 30 years ago.

Will you also tell us about some kinds of anxiety disorders?

One of the very common ones is generalised anxiety disorder, where the symptoms revolve around an individual not being able to allow for their mind to be still. You constantly have racing thoughts, there is a pressured speech when a person talks. You are ruminating over the same things, you are going in cycles over the same thing, and you are struggling with sleep. A person may also experience a large amount of restlessness, over a period of time. This doesn’t just happen over a day or two or three days. It is about three-to-four weeks of experiencing these symptoms continuously, which then can be diagnosed as an actual disorder.

One of the very common ones is generalised anxiety disorder, where the symptoms revolve around an individual not being able to allow for their mind to be still. You constantly have racing thoughts, there is a pressured speech when a person talks. You are ruminating over the same things, you are going in cycles over the same thing, and you are struggling with sleep.

Then there are the phobias, which are driven by childhood experiences, conditioning that has led to an individual developing a phobia over something. There is also social anxiety, awkwardness in relationships, constantly struggling with how one is supposed to be or not supposed to be in a social environment, that causes large amounts of anxiety which can cause symptoms like shortness of breath, sweaty palms, etc. These are some of the anxiety disorders.

When is the right time to see the doctor?

A lot of people struggle with sleep. They wake up feeling restless, become irritable, are unable to focus, unable to concentrate. If you have been experiencing these symptoms for two-three weeks, then I would say it is time for you to seek professional help, or to reach out to a therapist or a psychiatrist. You need to have a conversation with a professional therapist who is able to evaluate and decide what the next step would be — whether it is important to see a psychiatrist, be on medication or not. With a disorder you need to be on medication. Sometimes if you need medication and don’t get it, talk therapy that we do in counselling or in the psychotherapy process is pretty much inefficient because the individual will not be able to focus, or pay attention, or absorb the things that are being discussed in the session. Being on anti-anxiety medication will help calm the person and it will allow the therapy to work.

A lot of people struggle with sleep. They wake up feeling restless, become irritable, are unable to focus, unable to concentrate. If you have been experiencing these symptoms for two-three weeks, then I would say it is time for you to seek professional help, or to reach out to a therapist or a psychiatrist.

If there is anxiety related to specifically external stimulus, for example if you have an exam three weeks later, and you are feeling anxious about it, that is anxiety because of external stimulus, that sometimes might not need medication because you are having to adjust to a specific issue as compared to being anxious about multiple things which are not necessarily driven by external stimulus. In that context, seeking help and who you seek help from as the first step could differ. In this case, it can be a psychiatrist or a therapist. A good psychiatrist will prescribe medication and ask you to get counselling and therapy and refer you to someone, and a good counsellor or psychotherapist will refer you to a psychiatrist to be on medication if there is a need for it. It works well when both exist simultaneously.

Sources:

1. The burden of mental disorders across the states of India: the Global Burden of Disease Study 1990–2017.
2. Impact of Occupation on Stress and Anxiety Amongst Indian Women. Pinal Patel, Prerna Patel, Anuradha V Khadilkar, Shashi Ajit Chiplonkar

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