Tuesday, August 14, 2012

Why cognitive therapists love “anxious idiots”.

The Anxious Idiot

                                                       One day last year, I called my brother Scott in a state of agitation, self-hatred and incipient despair. Scott was at work and short on time. I got straight to the point. “I’m in a state of agitation, self-hatred and incipient despair!” I cried.
“Tell me more,” Scott said. “What is it?”
“I’m anxious — again! I’m anxious day and night. I wake up anxious and I go to bed anxious. I’m a total wreck. And I’m not doing anything to help myself! I know what helps and I’m not doing it! What’s wrong with me? Why am I not doing the things I know full well will make me feel better?”
“Oh,” Scott said. “That’s an easy one. It’s because you’re an idiot.” Then he said he’d call me after work.
When Scott called me an idiot, I initially took it as a joke — a bit of sharp-elbowed levity meant to nudge me out of my morbid self-involvement. As a brother, friend and fellow anxiety sufferer, Scott has license to make such jokes. And they help; they truly do. But the more I think about Scott’s comment the more I come to see it as containing real wisdom, as well as the power to explain one of the particular hells of anxiety: its tenacity.
Like many people who have been given a diagnosis of an anxiety disorder (and many who have not), I am always braced for the next recurrence. Anxiety, like the tide, is forever receding and returning, receding and returning. I have been experiencing this pattern for nearly 20 years now, so that my anxiety has come to seem, at times, inevitable and unassailable — a fait accompli. My anxiety, I’d concluded, is what I am. There is no escape.

Thanks to Scott, I am now coming to understand that this is not true. Thanks to Scott, I am now coming to understand that anyone, even the most neurotic of souls, can lessen and even elude anxiety, so long as he heeds a simple dictum: Don’t be an idiot.
I should define “idiot” for our purposes. I don’t mean someone of low I.Q. or poor academic abilities. Intelligence as commonly conceived has nothing to do with it. By “idiot,” I mean exactly what my brother meant when he tagged me with the epithet: an impractical and unreasonable person, a person who tends to forget all the important lessons, essentially a fool, one who willfully ignores all that he has learned about how to come to his own aid. A person who is so fixated on the fact that he is in a hole that he fails to climb out of the hole. An idiot, in short, is someone who is self-defeatingly lazy.

Laziness: it isn’t a characteristic usually associated with the anxious. Hysteria, yes. Clamminess, yes. A shrill speaking voice, often. But laziness? If anything, people tend to view the anxious as more active and motivated than normal, because they are more haunted by the specter of failure. And yet long experience has taught me that it is laziness — and not enclosed spaces, social situations or any other countless triggers — that is the foremost enemy of the anxiety sufferer, for laziness prevents him from countering the very patterns of thought that make him anxious in the first place.
It’s true that the anxious are rarely slothful in any typical sense. It’s more that we tend to be undisciplined, or somehow otherwise unwilling to see our anxiety for what it is — a habit of mind. To the argument that anxiety is not a habit but an affliction, I’d respond that the two are not mutually exclusive. Anxiety may come on like an affliction, but it persists due to habit. Or, to put this another way, just because you are afflicted with a mental disorder doesn’t mean that you can’t apply your conscious will to mitigating that disorder. Even if you use medication, as I do, to coax your nervous system in a more salutary direction, your will — your determination to act in a way that is counter to your nature — still factors in. Indeed, I am convinced it is essential to recovery.
This isn’t to say that being willful is easy. Anxious thoughts — the what-if’s, the should-have-been’s, the never-will-be’s — are dramatic thoughts. They are compelling thoughts. They are thoughts that have no compunction about seizing you by your lapels and shouting, “Listen to me! Believe me!” So we listen, and believe, without realizing that by doing so we are stepping onto a closed loop, a set of mental tracks that circle endlessly and get us nowhere. This makes the anxious habit very hard to break. Over time those mental tracks deepen and become hardened ruts. Our thoughts slip into grooves of illogic, hypervigilance and catastrophe.
My own mind, I am fairly certain, will always gravitate toward anxiety. And like many, I will often be disinclined to do anything about it. The reasons for this are no doubt complex and myriad. But it is certain that anxiety is exhausting and demoralizing: in many cases, as you listen to your anxious thoughts you get tired and apathetic. You get depressed. And that hopelessness, inaction and despair can become a sort of cocoon, a protective layer between you and the high-pitched terror of it all, and maybe, over time, even a painful and perverse comfort.
But that doesn’t mean — and here is the good news — that there is nothing we can do about anxiety. Indeed, there is plenty a person can do. The promising thing about a habit is that it is not the same thing as a fate. An alcoholic, we are told, is always an alcoholic — but not every alcoholic drinks. Similarly, an anxious person will always be at risk of anxiety, but he needn’t be troubled by it on a daily basis. He can avoid his own tendencies. He can elude his own habit.
To accomplish this, however, he has to work, and work hard. He has to fight — every day of his life, if he’s got it bad — to build new patterns of thought, so that his mind doesn’t fall into the old set of grooves. He has to dig new tracks and keep digging.
As for what that digging entails, I have my preferences. Over the course of my anxious life, I have found two reliable methods to keep my anxiety at bay: Zen meditation and cognitive-behavior therapy. Both methods teach, in their own fashion, that one’s thoughts are not to be taken as the gospel truth; both foster mindfulness and mental discipline. But you will likely have your own favored methods. You might find yoga, or exercise, or therapeutic breathing, or prayer are what work best for you. I’m not sure it matters what a person chooses — so long as he chooses and keeps choosing. So long as he remains dogged. Anything else, as my brother might say, is idiocy.

My comment:

Why cognitive therapists love “anxious idiots”.

Thank you Daniel Smith for a seriously playful approach to your anxiety. You are, with a liberating sympathetic attitude to your suffering, giving an intelligent description of a mental pain that a growing number of people thinks of as incurable. The unfortunate consequence is that you, and a too-large portion of our fellow human beings, become the high-paying victims and livelihood of the cognitive psychotherapy and the pharmaceutical industry. 

The fatal thing of being an “anxious idiot” is that the treatment providers, the cognitive therapists, are themselves “anxious idiots”, constantly on the run from any hint and confrontation that would remind them of their anxiety. The cognitive approach is, despite an apparent verbal flexibility, basically stereotype and seeks to eliminate the thoughts that lead to your anxiety and repression, and they hope to create “a positive substitute”. What they really are trying to do, literally and figuratively, is intellectually to convince both, themselves and you to reason away the pain behind your anxiety and repress it further. Which basically means for a brief time, then the pain / anxiety shows up on the point, in mind and body, where you are currently weakest. Just as you say: “I have been experiencing this pattern for nearly 20 years now, so that my anxiety has come to seem, at times, ineviteble and unassailable - a fait accompli. My anxiety, I’d conclude, is what I am. There is no escape”. 

Is there really no escape? After 40 years of searching and testing, I have learned that it is a tedious but far from impossible task. The kind of “perpetual mobile” that you have drawn up in your nice, close to emotional, description, of how the anxiety returns, can be broken if you learn to understand what it is about your emotional and intellectual processes that make you a prisoner in your own pain / anxiety.  You can eventually learn to understand what it is that makes it necessary for you to seek help from professional cognitive therapists who themselves, unconsciously, suffer from the same repression / pain / anxiety, which in your case means that the pain is leaking anxiety with an almost predictable regularity.

To treat a patient successfully it is imperative to take into account his/her psychological history that might contain abandonment, neglect, and experiences close to death. Most importantly,  a skilled therapist must consider an individual’s early physical and psychological development, and examine that critical period from gestation through the first three years of life, which science is just now beginning to recognize has so much to do with problems later in life. It is necessary to look at the person as a whole and consider the patient’s early history, taking into account physiological as well as psychological factors.

To quote my friend Dr. Art Janov: 

“Symptoms are the expression of imprinted memory /memories of experiences we had in our earliest moments that have been laid down neurochemically within our brain and nervous system. That is what lies in the primal universe—monumental emotions of imprinted memories that have been sequestered in the far reaches of the brain. For a patient to get well, it is necessary to access those memories in a safe way, bring them to conscious-awareness and finally to integrate them. When that happens the individual’s entire system is harmonized, key hormones are normalized, and the system is finally righted. After a connection is made between feeling-sensations and the thinking mind, perceptions are more accurate and a sense of calm and relaxation never before known is finally experienced.”

Yes, there is an escape!

Jan Johnsson