What Exactly Is Anxiety?

Anxiety and Modern Research

What is worry? In the first blog we discussed the experience of worry and in the second we addressed the multi-layered potential shaping influences that impact the degree to which we may struggle with anxiety. But what exactly is anxiety/worry? How do you begin to define it?

Let’s begin with the advent of modern psychology and psychiatry. A great deal of empirical research has been done over the past century. While these disciplines are quite young in many ways, they have proven to generate a wealth of observable data. When Christians stop and listen to the research, they are able to wisely engage rather than dismiss it out of hand. The following definition is an excerpt taken from the DSM Psychiatry Online Website:

Anxiety disorders include disorders that share features of excessive fear and anxiety and related behavioral disturbances. Fear is the emotional response to real or perceived imminent threat, whereas anxiety is anticipation of future threat. Obviously, these two states overlap, but they also differ, with fear more often associated with surges of autonomic arousal necessary for fight or flight, thoughts of immediate danger, and escape behaviors, and anxiety more often associated with muscle tension and vigilance in preparation for future danger and cautious or avoidant behaviors. Sometimes the level of fear or anxiety is reduced by pervasive avoidance behaviors. Panic attacks feature prominently within the anxiety disorders as a particular type of fear response. Panic attacks are not limited to anxiety disorders but rather can be seen in other mental disorders as well.

Here is a list of classifications of worry that can be found in the most current version of the Diagnostic and Statistical Manual of Mental Disorders V (DSM V). Where possible, screening questions from Allen Frances’ book, Essentials of Psychiatric Diagnosis, are included in italics:

• Separation Anxiety Disorder: Is your child inordinately scared of separations?
• Selective Mutism: the voluntary refusal to speak (typically occurring outside the home or immediate family).
• Specific Phobia: Do you have a particular fear that causes you special trouble, like flying, heights, closed places, animals, seeing blood, or getting an injection?
• Social Anxiety Disorder (Social Phobia): Do you frequently avoid social situations because you are afraid of doing something stupid or looking silly?
• Panic Disorder: Have you ever had a panic attack?
• Panic Attack Specifier: A panic attack associated with a certain trigger (social anxiety, etc.).
• Agoraphobia: Are there many things you’re afraid to do and many places you’re afraid to go?
• Generalized Anxiety Disorder: Are you a ‘worry-wart,’ unnecessarily anxious all the time about a lot of different things?
• Substance/Medication-Induced Anxiety Disorder: Have you had a lot of anxiety symptoms associated with using drugs, drinking alcohol or coffee, taking medication, or withdrawing from drugs or medication?
• Anxiety Disorder Due to Another Medical Condition: Have you had symptoms of anxiety in association with a medical condition, like and overactive thyroid?
• Obsessive-Compulsive Disorder: Do you ever have weird thoughts that you can’t get out of your mind? Are there rituals you can’t resist doing over and over and over and over again?
• Post-traumatic Stress Disorder: Have you experienced a traumatic event that keeps haunting you in terrible memories, flashbacks, or nightmares?

Below is a helpful chart that compares “normal” anxiety and “abnormal” anxiety.

Everyday anxiety or an anxiety disorder?

What are we to make of this information?

While this is a very brief representation of the data, it still begs the question, "How can we engage this information and learn from it?" Here are some initial thoughts:

1. We can certainly learn a great deal from this descriptive material. When someone tells you that they are struggling with anxiety, it is not uncommon to assume you know what they mean. You often extrapolate from your own experience of anxiety or others whom you have helped in the past. But that would be a mistake. These various descriptions help you to see how complex each and every person’s struggle with anxiety can be. The data teaches us to be more curious and to ask more questions as we get to know the particular contours of a person's struggle.
    
2. If you are not careful, it may seem like the person who is high-functioning with “everyday” anxiety is normal and okay. Yet, biblically, every person is in need of God’s help no matter how seemingly small or big the problem. In the chart above, the person in the left column needs to be as vigilant about their low-grade anxiety as the person with a more intense struggle. No matter where you fall on the worry continuum, each and every person should be asking these questions on a daily basis. We will see why this is so important when we begin to see how Scripture defines worry.

• “How can I love God and neighbor more fully regardless of my level of struggle with anxiety?"
• “How can I be more and more conformed into the likeness of Jesus?”

Living without worry

By Timothy Lane

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3. It might be tempting to think that the person who is high-functioning has a deeper faith than the person who struggles more intensely. But that is not necessarily so. Someone who struggles more intensely with anxiety may actually have a more robust faith than the person whose struggle is less. The Scriptures remind us again and again that the weak know their need of God’s grace while the “strong” may be falsely self-confident and self-reliant.

4. Finally, you may conclude that these diagnoses are similar to a medical diagnosis. You might conclude that the person “has” a psychopathology in the same way a person has a medical pathology or disease. While there may be an organic aspect to the person’s struggle, the DSM V categories are largely, if not only, descriptive. They are describing thoughts and behaviors that are observable. The cause may be largely unknown.

Please share your thoughts in the comment section below. In the next post, we will begin to see how Scripture defines anxiety.

Copyright © 2016 Timothy S. Lane

What Causes Us To Worry?

Everyone worries. Some of us more than others. Reports show that nearly 20% of people living in the US struggle with anxiety. That means that approximately 65 million people experience worry that impacts their daily lives and relationships in profound ways.

In 2008, American physicians wrote more than 50 million prescriptions for specifically anti-anxiety medications and more than 150 million for antidepressants, many of which were used for anxiety-related conditions.

Causes for Worry

So why do so many of us struggle with anxiety? That question has been at the center of much debate. The pendulum has swung from one extreme to the other throughout history. Some have thought that worry is purely a physiological issue while others have concluded that it is purely spiritual. Alan Horwitz states this in his book, Anxiety: A Short History:

Between the fourth and sixteenth centuries, religious, magical, and folkloric views of anxiety and other mental conditions largely displaced empirically-based Hippocratic and Galenic conceptions in Western societies. While the latter beliefs persisted within medicine through the medieval period, medical knowledge itself was overridden by ecclesiastical structures. Over the course of the seventeenth century, however, anxiety was once again increasingly likely to be viewed within a medical, as opposed to spiritual, framework. Within medicine, the influences of humoral pathology, which had dominated medical thinking since Hippocratic times, gradually waned. By the end of the eighteenth century, while humoral conceptions remained popular theories of temperaments in the general culture, medicine preferred physiological accounts to explain how mental disturbances resulted from malfunctioning nervous systems (p. 54).

While Horowitz’s view of the church may be oversimplified, we still must ask: what causes anxiety? Does the Bible provide categories that enable us to avoid the swinging pendulum between faith and science? I believe it does.

The historic Christian categories of World, Flesh and Devil are entirely capable of providing a robust understanding of people and their problems, allowing us to avoid simplistic reductionism on either end of the spectrum. We don’t have to engage in either/or thinking and conclude that anxiety is either purely physiological or only spiritual. This means that we can learn from the best insights that modern science has to offer along with the rich truths of Scripture which remind us that God is able to meet us in our struggles with worry.

Below is a simple diagram that captures the many shaping influences that may be relevant to any particular person’s struggle with worry.

World

The category of “world” is everything outside of the heart. These are the external shaping influences that we experience as human beings made in God’s image. It is the person’s situation; their context. To minimize the impact someone’s circumstances has on a person is to be sub-biblical. The God of Scripture takes our situation seriously. This is a place where we can learn most from modern scientific research:

• Brain: we all have brains that determine our personalities and pre-dispose us to a host of struggles. All of us are constitutionally wired differently. Our brains are also impacted by the fall of humanity. We are all broken at some level and exhibit various mental strengths and frailties.
• Body: we have bodies that have strengths and weaknesses. They too are broken in different ways and impact how we respond to difficulty.
• Event and Relational History: we have good and bad things that have happened to us along with people who have blessed us or hurt us.
• Political/Cultural/Socio-economic Context: we exist in a context that impacts the degree to which we may struggle with worry.
• Gender: our gender plays a role in how we struggle with worry.
• Religious Upbringing: the beliefs that shaped us growing up influence our struggle with worry.
• Age: the longer we live, the more grief and loss we experience. This can make us wiser or more prone to anxiety.
• Race/Ethnicity: whether we are the majority or minority culture in a given context will also shape the way we experience anxiety.

This list is not exhaustive. You may be able to think of other external shaping influences. Each one can be nuanced to fit every person who has ever lived. No two people are alike.

While we take all of this seriously, it is important to note something interesting about the struggle with anxiety. While appreciating one’s context, changing one’s context does not guarantee that you will live a worry free life.

Once again, Alan Horwitz states this in his book, Anxiety: A Short History:

Modern developed societies are the safest, healthiest, and most prosperous that have ever existed so we might expect that their citizens would have low levels of anxiousness….
Nevertheless, surveys inform us that the public reports more anxiety disorders now than in the past. These studies indicate that anxiety is the single most common class of mental illness; almost one in five people has had an anxiety disorder during the past year and more than a quarter of the population experienced one at some point in their lives (p. 143).

Certainly there is nothing wrong with changing your circumstances if you are in danger, but situational change does not mean you will be anxiety free. There is a need for more.

Flesh/Heart

This category factors in the reality that we were created by God to worship and trust in him in the midst of our circumstances, no matter what they are. This is where the Bible focuses most of its attention. It does so, not because it is simplistic, but because it offers something that no other theory of change offers; a personal, loving, redeeming God who becomes a human being, lives, dies and is raised from the dead to give us new life, wisdom and power to live in relationship with him! The Bible does not minimize the category of “world” at all. Yet it does call us to depend upon and trust in God in the midst of our joys and sorrows.

Devil

This category is factored into the Biblical worldview because it recognizes that evil is real and personal. While most attention is focused on the other two categories, the Bible does clearly state that we have one who is opposed to God’s people and he seeks to tempt and accuse those who follow Christ. In Ephesians 6:10-20, the apostle Paul gives clear instruction on how to fight the schemes of the Evil One. When this category is improperly over-emphasized, it can lead people to look for demons in every pathology. When it is improperly under-emphasized, it can lead people to miss the real battle that is part and parcel of the Christian life.

Modern psychology and psychiatry attempt to capture the multi-layeredness of people and their problems by talking about the bio/psycho/socio/cultural aspects of causation. The Biblical worldview allows us to take those categories seriously along with painting an even fuller, more nuanced picture. Whether the church has always represented this level of nuance is something to debate, but the Scriptures are clear.

Patience and Compassion

One of the most relevant aspects of understanding these three categories is to fully appreciate the multi-layered nature of anxiety. When we do this, we can understand why some people may struggle more than others. The more layers that are involved, the greater the struggle and the harder it may be to change.

If you struggle with severe anxiety, this can help you calibrate your expectations and not live under a cloud of shame because of your struggle.

If you are someone who is helping someone who struggles deeply, these categories can move you to greater empathy and compassion. They can also help you see that, even in the midst of a struggle with anxiety, the living, redeeming God wants to meet you in your troubles and comfort you and walk with you.

Copyright © 2016 Timothy S. Lane

Is Worry Making Us Sick?

Any quick search in Google or Amazon will confirm what we all already know; worry is harmful to our bodies. Here are a few physical symptoms associated with worry:

• Difficulty swallowing
• Dizziness
• Dry mouth
• Fast heartbeat
• Fatigue
• Headaches
• Muscle aches
• Muscle tension
• Nausea
• Rapid breathing
• Sweating
• Trembling and twitching

You can almost get exhausted and anxious reading that list. All of these can be experienced to varying degrees depending on how severe your worry is. Most of you can probably identify many of these as you reflect on an anxiety-producing experience in your life.

Unfortunately, this is not the only way we are impacted by worry. If not addressed, it can have a bigger impact on your overall health. People who worry consistently are more prone to the following physical consequences:

• Suppression of the immune system
• Digestive disorders
• Short-term memory loss
• Premature coronary artery disease
• Heart attack

In light of this, it is not surprising when we discover the original meanings of the words we use today to talk about worry and anxiety. The English word “worry” comes from the Old English word meaning “strangle.” The word “anxiety” is of Indo-Germanic origin referring to suffering from narrowing, tightening feelings in the chest or throat.

Statistics reveal that nearly 20% of people living in the United States will experience life debilitating anxiety annually. That is nearly 65 million people! In 2008, American physicians wrote more than 50 million prescriptions for anti-anxiety medications and more than 150 million prescriptions for antidepressants, many of which were used for anxiety-related conditions. It is no over-statement to say that we have a problem of epidemic proportions.

What Would Your Doctor Say?

Physicians and counselors will tell you that diet, exercise, rest and some kind of meditation is a proven help when you are struggling with anxiety. Sometimes medication, when taken wisely, can be helpful. You can use your body to fight what is actually trying to undermine it. No one can deny that. But is there another part of dealing with worry that we need? While these things are important, we also need to know how to connect to God when our worries come. We need God’s grace even if we are going to pursue exercise and diet in a way that is most helpful.

Let’s consider the most fundamental aspect that must under-gird everything else we do when taking care of our bodies.

What Would Jesus Say?

Jesus lived at a time in human history that was very unpredictable and less safe than ours. It was a world in which worry was epidemic, too. In every instance where he encouraged people not to worry, he did so with compassion because he knew first-hand what it felt like to be a human being. In Luke 12:32, he spoke these encouraging words to anxious people, Do not be afraid, little flock, for your Father has been pleased to give you the kingdom. Those simple words sum up all that Jesus said over and over again. He commands them not to worry, but his command is one of encouragement, not shame. Let’s consider these simple but profound phrases:

Do Not be Afraid

Jesus knows that worry is a serious problem. He knows it is bad for you physically, as well as spiritually, and he gets right to the point because he loves you. His commands are always for your good. Whenever you are struggling with worry, it is connected to your relationship with God. The word “worry” that Jesus uses means “a divided mind.” Within the broader context of his teaching, Jesus says that worry happens when you try to love God and something in creation at the same time. As soon as you do this, you have begun to put your hope and security in something other than God. Anything else besides God is unstable (money, a relationship, a job, education, your own moral record, obedient children, your health). Do you see why Jesus is so straightforward? He cares for you. He knows that you can’t serve two masters (Matthew 6:24).

Little Flock

At the same time that Jesus speaks strong but encouraging words, he does so with a tone that is tender in its toughness, and compassionate in its candor. Don’t let this little phrase that Jesus utters evade you. Don’t miss those two powerful words: little flock. While Jesus challenges you to not worry or fear, he speaks to you as one who belongs to him, whom he is shepherding and for whom he laid down his life. You are unimaginably dear to him and loved by him. You are one of his sheep. Be reassured—he cares for you and loves you even as you struggle with worry, even as you forget him and his care, and give in to your tendency to worry. You may be prone to wander, but you will always be part of his flock.

For Your Father Has Been Pleased to Give You the Kingdom

If the promise of Jesus’ tender care is not enough, he adds something more! Your Father is not only going to care for you now, he is in the process and will ultimately give you His kingdom. Your future is certain and you can begin to experience it even now because His kingdom has broken into your life by the presence of the Holy Spirit. He is a deposit guaranteeing that you will get it all one day. So, right now, in the ups and downs of life, the stresses and strains of the uncertain future, let the certainty of your eternal future be what you cling to.

With all of this in mind, allow the truth of God’s care for you to work its way into your daily life. We are to prioritize the kingdom by viewing everything through the lens of our faith. When you begin to live for God instead of the things of the world, you may find that your tendency to worry will lessen and your response to God and to the world, spiritually and physically, will change dramatically.

Copyright © 2015 Timothy S. Lane

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This is an adapted excerpt from Tim’s latest book, Living Without Worry, which can be purchased through The Good Book Company or on Amazon.

When Culture Feels Scary

When you reflect on the past month in the U.S. -- the recent SCOTUS rulings, racial tension and debates over immigration policy, to name a few -- do you find yourself pessimistic and fearful or optimistic and hopeful? Depending upon where you stand on particular issues, a wide variety of responses can be seen. For some, it may evoke celebration. For others, deep sadness. Some, anger, and for many, a great deal of fear. Yet, looking at our particular zeitgeist in comparison to what believers in the Old Testament and the New Testament faced has a way of providing helpful clarity as well as deep optimism. Yes, I said optimism! I am talking about deep biblical optimism, not pollyannish optimism.

In order to get some perspective, let’s consider one example from the life of the Apostle Paul. In Acts 18, we learn that he is near the end of his second missionary journey. He is leaving Athens and heading to Corinth. That, in and of itself, is worth considering. Paul’s time in Athens bore little fruit as far as we can tell. There was no successful church plant there that we are aware of. As Paul leaves Athens and arrives in Corinth, he says this,

I came to you with great fear and trembling (I Corinthians 2:3).

Prior to his time in Athens, Paul had experienced significant persecution for his work of spreading the gospel. The bottom line is this; Paul is struggling with fear as he faces opposition. He is a minority in the cities where he moves and preaches the gospel. He is outnumbered. People think he is crazy and narrow-minded. He is an outcast. His values are at odds with the culture he is moving and living in. Corinth, itself, was a challenging city. Not unlike many of our modern cities in the world.

It is within this context that Jesus speaks to Paul in Acts 18. Listen to what Jesus says and how it is very relevant for believers today.

9 One night the Lord spoke to Paul in a vision: “Do not be afraid; keep on speaking, do not be silent. 10 For I am with you, and no one is going to attack and harm you, because I have many people in this city.” 11 So Paul stayed in Corinth for a year and a half, teaching them the word of God.

The last phrase in verse 10 is a game changer as we ponder how we relate to our culture as Christians. Paul certainly hears words of encouragement that bring new strength and resolve to his efforts. Jesus promises to protect him and be with him in the midst of his work in Corinth. But Jesus goes another step. It is a positive statement that changes Paul’s perception of those he will encounter as he goes about his gospel work.

Jesus says that many of Paul’s present adversaries will be his future brothers and sisters in Christ. Not all of them will. Paul will experience ongoing persecution and rejection. That comes with the territory as we follow the King of a very different kingdom. Yet, as Paul relates to his current enemies with a tone and posture of grace, conviction, humility and tenacity, people will find hope and grace in the One whom Paul knows and proclaims.

How are we doing as a church in the 21st century within the context of our culture? Are we pessimistic or optimistic? Do we live in fear or in hope of the advancing kingdom of God; a kingdom of grace, mercy, forgiveness and joyful repentance?

What about your particular church? Do we see the cultural challenges of the day as opportunities for pastoral apologetics; a winsome and persuasive display of God’s kindness and call to a changed life?

What about you? Do your family members, co-workers and neighbors enjoy your company or hope you don’t show up due to your strongly held opinions and the way you express your convictions? Are you fearful and self-righteous?

Paul’s tone and demeanor shifted radically upon receiving Jesus’ counsel. It is the same counsel that you are receiving today. The King is on the move rescuing folks just like you and me. In fact, he wants to use folks just like you and me. We have an opportunity to be the church and represent our gracious King. This starts by building bridges and connecting with people; especially with those whom we may disagree.

Sound scary? If so, know that you have the same promises and encouragement from Jesus as Paul did as he moved to Corinth.

Copyright © 2015 Timothy S. Lane

Until the Dawn Appears

My daughter introduced me to Matthew Perryman Jones. That led to a birthday gift to see him at a classic, small venue in Atlanta, Georgia. Jones grew up in the greater Atlanta area and got his start where we saw him. We arrived early and managed to get a table that was about 3 feet from the stage. Early on, he sang a song entitled "Until the Dawn Appears". He said it was a song about hope. Ironically, it is a song about sorrow and suffering.

I like how the song does not tie up all the confusing realities around suffering, while still capturing a Christian vision of wisdom and hope. It is also one of many ways that God comes to us in our sorrows. Songs and lyrics touch someone at a level that mere words sometimes do not. Poetry is intended to capture the whole person.

Before listening to the lyrics, here are some thoughts on the song's content:

1. Stanza one encourages the listener to take a good look at one's sorrows. This is helpful because the inclination is to avoid and not grieve.

2. "How Long"....is the cry of the Psalmist. It is also the appropriate cry of the believer. "How Long, O Lord, will you allow this to go on and on?"

3. Stanza two is a wise calling to avoid any form of bitterness or self-medication in an attempt to kill one's sorrows. If you do, they will take over your entire life and soul.

4. Stanza three introduces the Man of Sorrows and a Crystal Sea. Crucifixion, Resurrection and complete Cosmic Restoration. This stanza moves you through these epoch aspects of the Christian faith. No other world religion can offer this kind of hope.

5. Ending Chorus: Words of comfort for the child of God. He will not let us go!

I’ve been turning up the stones in my own discontent
And I’m finding out where all my hidden sorrows went
They’ve been laying there for years,
I kept them out of view
But it's time I dust you off and take a good look at you

Oh how long?
Oh How long?

Well it's easier to clench your fist and grind your teeth
Then to look into the sadness that lives underneath
You can kill off all those feelings
They’ll just turn to ghosts
They will take over your house and become the host

Oh how long?
Oh how long?

Well the Man of Sorrows walked the shores of Galilee
And his eyes were cast with joy towards the crystal sea
Well the shadows will be gone and all these bitter tears
And my heart will hang on that until the dawn appears

Oh how long
Oh how long
Oh You, You won’t let me go
Oh no, no. 
Oh no You won’t let me go
Oh no, oh no, You won’t let me go
Oh no, oh no You won’t let me go

Copyright © 2014 Timothy S. Lane