Anxiety: a very modern malaise
With 7 million tranquilliser prescriptions on the NHS, the nation is at the end of its tether. What’s to blame?
Life was flying along for Zoe Brook. At 23, she had a fast-paced job she loved, in public relations, and had just moved into her first home with her then-partner. It was, she says, all that she had dreamt of.
That was until the night she sank to the floor, paralysed by fear, her own voice sounding muffled and as though on a time delay, while her view of the room darkened into the narrowest tunnel vision.
She thought she was dying. In fact, it was the start of an anxiety disorder that was to become her new reality, and to dominate her twenties. After finally sleeping, she awoke disorientated and petrified – a state that continued for more than three years, in which waves of panic attacks were “punctuated with glimpses of the real world”.
Looking back, she believes the anxiety was her body’s response to a pace of life she could not sustain. “When everything is busy and going well, you just keep on going. Then suddenly you look down and see that there is nothing anchoring you; and so you fall.”
She is not alone. Last year, close to 7 million prescriptions were issued by the NHS for anti-anxiety drugs. As economic woes have worsened, and job and mortgage worries become rife, the numbers being treated in hospital for such disorders have soared – with more than 17,000 outpatients’ appointments last year, four times as many as in 2007.
As Britain enters the Age of Anxiety, great swaths of the population appear to be nearing the end of their tether.
However, Dr Linda Blair, a clinical psychologist, believes that economic pressures are aggravating a far deeper problem; that modern technology, with its ability to bombard us with messages 24/7, has rendered many of us unable to “switch off”.
“We have actually created a more anxious state,” she says. “When our brain is expecting some kind of news, we prime ourselves to be on alert. With texts, emails and social media, on top of images from TV news, we are constantly on alert, and that can make people chronically anxious, and chronically exhausted.” She advises her patients to take some time away from their gadgets at least once a day – even if it is just for 10 minutes.
Dr Joanna Moncrieff, a consultant psychiatrist and senior lecturer at University College London, agrees and is concerned that Britain is following the path trodden by America in medicalising a social problem instead of examining the values behind it.
“We live in a culture that makes people anxious,” she says. “It encourages the idea that everything can be achieved or bought, that 100 per cent is not enough, that you have to be the perfect wife and mother, and succeed in your career.”
Meanwhile, too much faith has been invested in scientific progress, therapy and a pill for every human ill. “And we have become less able to tolerate and endure life’s ordinary difficulties.”
There has certainly been a distinct shift in the public image of anxiety disorders and the drugs used to treat them. While Valium earned a reputation as “mother’s little helper” among 1960s housewives, by the 1980s the group of benzodiazepines had become better known as “jellies” and “benzos” by recreational users seeking a high.
Today, the same group of drugs are being discussed in far glossier circles.
Earlier this month, Alexandra Shulman, the editor of Vogue, admitted she has regularly suffered panic attacks – and always carries some Xanax in her handbag as her “lucky charm”.
British supermodel Jodie Kidd and her sister Jemma, the Countess of Mornington, have both undergone successful treatment for anxiety and panic attacks which they described as “crippling”.
“The attacks felt like that split-second before a car crash, when the adrenalin whooshes through your body and you think you are going to die,” says Jemma. “From the outside, I might have looked sorted, but on the inside, I was thinking ‘if only you knew… ’ ”
Both checked into the Linden retreat, in Worcestershire, also the choice of British novelist Plum Sykes.
Ms Sykes’s anxiety followed the onset of a rare migraine disorder that left her so dizzy she couldn’t care for her children. Though treatment for the condition was successful, the fear of such attacks left her virtually housebound, unable to take even the few steps from her home into a taxi unassisted.
“Life became a series of ‘what-ifs’.” she says. “I would imagine every possible worst-case scenario which could occur. In the end I became too frightened to do anything at all.”
In an article for US Vogue this month, she wrote about her stay at the retreat, and the dinner conversations with 11 other anxiety sufferers, including a 23-year-old policewoman who experienced panic attacks when her baby refused food.
“You must be terrified at work then,” Ms Sykes sympathised, “dealing with criminals and everything?”
“ ’Work’s fine,’ the policewoman cheerfully replied. “I just lock offenders in a cell. I’m not afraid of them. It’s when I’m at home that I’m anxious.”
When a person is fearful, the body is flooded with adrenaline in order to prepare it for extreme muscular activity, commonly known as the fight-or-flight response. In panic attacks, these reflexes are triggered despite an apparent lack of external threat, causing a response in the sympathetic nervous system with intense physical symptoms, including tunnel vision, hyperventilation and racing palpitations.
While the NHS prescribes drugs and, increasingly, cognitive behavioural therapy, to identify unhelpful thoughts and actions and replace them with constructive ones, the retreat’s founder, Charles Linden, an anxiety-sufferer for more than a decade, is adamant that when it comes to anxiety, neither approach works.
Instead, clients are given individualised programmes to follow, in Ms Sykes’s case insisting that she timetabled activities for every half-hour of every day so there was no time to look ahead and worry.
The Kidds and Ms Sykes are among many celebrity clients who say they have been cured by The Linden Method.
But Frank Furedi, professor of sociology at Kent University, fears that Britain has developed a culture that not only feeds and encourages anxiety, but also wears it as a badge of pride.
“At London dinner parties, everybody has a condition, an anxiety to talk about; if you don’t, there is something wrong with you. It has become normal and fashionable to be anxious; it is a little bit edgy,” he says.
He believes two twin forces are at work; that children are taught to “medicalise the everyday”, and learn a language of stress and anxiety, while our political classes have identified happiness as a public goal, with David Cameron last summer announcing plans to rate the country not just by its gross domestic product, but by the well-being of the public.
“In the Second World War, we maintained the stiff upper lip. Today it is almost the opposite. The message is to call a helpline, get support, find somebody to help you. If you aren’t opening up and talking about your problems, then you are seen as morally inferior,” Dr Furedi argues.
Certainly the past 60 years have seen a vast expansion in psychiatry, and in the redefinition of social problems as medical complaints.
In 1952, the first edition of the US Diagnostic and Statistical Manual of Mental Disorders, the psychiatrists’ bible, that classifies mental illnesses, was 130 pages long and listed 106 psychiatric disorders. Today’s checklist, used across the world, runs to 900 pages and 297 disorders. A new version is due next year.
One of the most significant expansions, under psychiatrist Dr Robert Spitzer in 1980, led to the introduction of “generalised anxiety disorder”.
In recent years, Dr Spitzer has criticised his own work, suggesting that the criteria were so broad that up to 30 per cent of the population without serious mental health problems could fall under its classifications.
At Anxiety UK, the main charity for people suffering from anxiety disorders, phobias and panic attacks, chief executive Nicky Lidbetter believes people in this country have simply become more aware of conditions that have always existed, even if they went unnamed.
“I had a grandmother who was agoraphobic; we just didn’t have a word for it,” she says.
She sees first-hand how severe such disorders can be. “At worst, these can render a person housebound, or even roombound,” she says.
Ms Lidbetter also takes the view that modern technology and fragile economic conditions are putting increased numbers of people at risk. “People can usually cope with short bursts of pressure but what is much more difficult is situations of prolonged uncertainty, when there is no end in sight; conditions like our economic situation,” she says.
Stress can spur success, but it needs to be at a constructive level. As pressure ratchets up, coping mechanisms can falter. “When there is job insecurity, people take on more work than they can handle, they start surviving on coffee, not eating properly, and dropping the things that kept them well, the leisure activities, the trips to the gym,” she says.
She describes panic attacks as the “body’s internal alarm system”, sending a warning to slow down and take stock.
In Cheshire, Zoe Brook no longer suffers from anxiety. The mother-of-two has trained as a therapist, helping others with such disorders.
After three years of drug treatment, she learnt, by trial and error, to manage the warning signs.
Mrs Brooks describes anxiety as “a battle in the mind” and one that occurs not during the times of most pressure, but in the hours, days and weeks after – “the quiet times, when thoughts can rise to the surface”.
“The attacks paralysed me,” she says. “When I felt them coming, I used to grip the arm of the chair and steel myself for the wave. Then I realised you had to break it; to get up, to do something mundane, to take a deep breath, to potter about, to do anything.
“I began to realise that the best response was indifference – to laugh in the face of an attack.”
These days, when the going gets tough, she tries a different tack. “Now, I take a moment to lie on the grass, to look at the sky, and to see the shapes in the clouds. Sometimes you just have to stop and catch your breath.”