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