“…Kids are different today, ” I hear every mother say
Mother needs something today to calm her down
And though she’s not really ill, there’s a little yellow pill
She goes running for the shelter of her mother’s little helper
And it helps her on her way, gets her through her busy day…”

                                  Mother’s Little Helper, The Rolling Stones

    In 1966, a bluesy rock song penned by Keith Richards of The Rolling Stones paid homage to the tranquilizing drugs which had become the rage, in an age of anxiety defined by the “rat race” and by the development of the psychopharmacologic approach to life’s problems. The title of the song, Mother’s Little Helper, reflects the predominance of women as the recipients of drugs that treated anxiety and the lyrics are a succinct representation of the dilemma of the diagnosis of anxiety. Is anxiety a mental illness, and, if not, what is it?

    Anxiety has been defined in many ways over thousands of years. For the classicists of Rome and Greece, the words used to describe anxiety as illness were nuanced.  Some referred to a mental feeling and others to bodily sensations, and they all conveyed a sense of constriction. As far back as the oldest book in the Bible, the character Job, in his anguish, speaks of “the narrowness of my spirit.” A different aspect of anxiety appears in one of the Romance languages, in the Romanian word nelinişte, meaning unrest. Between the ancients and the modern era of psychiatry, the concept of anxiety as a unique disorder goes dormant, with the symptoms buried in other diagnoses referring to emotions, particularly melancholia and neurasthenia. But by the time of the first Diagnostic and Statistical Manual of Mental Disorders in the early 1950s, anxiety was back, categorized as a mental disorder, with progressively more sub-categorizations related to associated behaviors over the next four updates to the guide. Anxiety disorders are said to affect almost a third of US adults at some point in their lives, and are rising among children as well.

    There are clearly people for whom the emotion of anxiety is crippling, interfering with the ability to navigate in the world, to accomplish necessary tasks of daily life, and to use the potential they have to live the best life they can. For these people, anxiety is a disorder. And anxiety complicates other serious mental illnesses like depression and schizophrenia. But anxiety is also normal, a feeling of dark expectation that is part of being human. Everyone experiences anxiety intermittently. Sometimes it keeps us awake. Sometimes it interferes with plans. Sometimes it helps us avoid problems. Sometimes it lingers longer than usual. Given the very high frequency of anxious feelings, learning about why anxiety occurs and about how to cope when it appears may be very helpful.

Anxious feelings are a protective. Because we are vulnerable creatures in a world filled with danger, we evolved to recognize, respond to and figure out how to avoid things which threaten us. The parts of the brain charged with this task are the amygdalae, paired almond-shaped structures deep in the brain on each side, near the temporal lobe. The connections to and from the amygdalae are complex and extensive, and the circuits trigger two emotions when we face unfamiliar, potentially threatening situations: fear and hope. Fear focuses attention and freezes motion, while triggering the physiologic responses necessary to fight or flee. Hope is the emotion that emerges when memory scanning triggered by the amygdalae yields recognition of a pattern in the threat. Hope enables development of a plan of action. Anxiety is the dark apprehension we feel when we cannot find the way to a plan to deal with persistence of the fearful, or just plain unresolved situation.

   Anxiety has three components. First, an alarm reaches each amygdala through the senses and triggers fear and memory scanning. The alarm encounters the second component, a mixture of beliefs based on prior experiences stored in memory.  The third component is the coping behavior that emerges.  Coping behaviors may be unsuccessful in reducing the fear, or unable to resolve the situation because of conflicts with beliefs.  When coping is unsuccessful at restoring calm, anxiety carries on, a dread sense sometimes accompanied by restlessness, nervousness, tension, sweating, weakness, shaking, rapid heart rate and hyperventilation, spilling over into non-threatening situations. When normal life is compromised, or unsuccessful coping behaviors like substance abuse take over, anxiety becomes a mental disorder.

    Some of us have more anxious temperaments than others, but everyone can work to better cope with fear-provoking situations. The less chaotic our lives, the fewer the confrontations with the unknown are – but control can never be perfect and lack of control itself can cause fear and, hence, anxiety. many of the patterns we establish in our lives, such as regular habits and ordering our environments we have learned unconsciously as a means of keeping anxiety under control. Countermeasures like the techniques of cognitive behavioral therapy (CBT) are not only useful but can be done as self-help. There are numerous cognitive behavioral therapy resources available in libraries and online. They teach recognition of the common distortions of thinking that lie beneath chronic anxiety, and ways to correct them. Interestingly, CBT is quite similar to the recommendations of the classic Epicurean and Stoic philosophers who wrote about anxiety so long ago.

    When anxiety disrupts life and does not yield to attempts to change, the professional help of a cognitive behavioral therapist is in order, as well as a general medical checkup to rule out problems like hyperthyroidism or Vitamin B12 deficiency.  Sometimes a therapist will add a pharmaceutical product, usually one in the SSRI category of antidepressants. While the “mother’s little helper” class of drugs, the benzodiazepines, are very effective in reducing acute anxiety, more chronic use has led to significant, refractory addiction problems, and SSRI-type antidepressants are a better choice to begin with if drugs are going to be tried. If drugs are employed they should not be a substitute for the hard work of understanding how the interaction of personality, experience and environment lets a useful and protective emotion become untethered from its purpose. Such understanding can help the mind move forward into solutions.