Living with Mental Illness : Understanding Anxiety

I have written a couple of posts related to mental health issues. One thing that came through very strongly in the feedback was that whilst people were sympathetic, many admitted to knowing very little about Post-Traumatic Stress Disorder (PTSD). I thought I would write a little bit today about PTSD in order to help people get a better understanding of what this thing actually is.

I need to highlight I am not an expert in this field. What follows is simply my understanding of my condition. The observations that I make will be based almost exclusively on my own experiences. Everybody’s experience of mental illness is different, so it’s important to realise that just because this is how mental illness affects me, the points I make may not be relevant for others. That said, I do have a number of people in my life who suffer from mental illness in one form or another and it’s been my experience that some of the themes that I’ll discuss re-occur consistently in many cases.

If you want to read some of my previous articles on this topic they can be found here:

Living with Mental Illness - A First Person Perspective

Living with Mental Illness: I Don't Just Listen to Sad Songs

Post-traumatic stress disorder may sound intimidating as a label, but at its heart it is simply an anxiety disorder. It is specific type of anxiety disorder with very specific causes and triggers, but it’s just anxiety all the same. There is an enormous amount that I could write about anxiety. For today though I’m going to focus on one specific aspect: emotional regulation.

Emotional regulation is a fancy way of saying how well someone is able to control their own emotions. When someone suffers from an anxiety disorder, quite often this will manifest itself is as an inability to control emotions. An extreme example of this may be when someone suffers a panic attack. This generally occurs when the situation that the person finds themselves in is so overwhelming that they are unable to cope with the level of stimulation in their environment. A person suffering from anxiety may experience a panic attack in a situation that might cause anyone to feel slightly anxious. They could also suffer one in a situation that to another person may seem completely unremarkable. In either case, for someone with anxiety, their inability to control their emotions may result in the situation escalating inside their own mind into something which is completely unmanageable.

To give a personal example, I recently suffered a panic attack whilst travelling in Thailand. Panic attacks are not something which I experienced regularly, but when they do occur they can be debilitating. In this instance I was travelling alone in Thailand, and needed to get from my hotel in one part of Bangkok to a train station that was on the other side of the city. From here I would catch an intercity train to my next destination. Objectively this required me to walk some 400 m from my hotel to a metro station, catch a train for about 10 minutes, change trains to another line, and catch a second train to my final destination, the main station in Bangkok. For many people this would be a relatively routine activity. At the time however, I had been travelling alone for four days and was in a country where I didn’t speak the language, nor could I understand the signs that directed me to the various platforms and trains that I needed to catch. I was concerned about both my ability to catch the right train to get to where I needed to be, and also whether I would reach my destination in time to catch my connecting train to northern Thailand. This is where my lack of emotional regulation kicked in.

The beauty of suffering from an inability to control your emotions is that inside your inside your own mind, relatively simple things escalate out of proportion very, very quickly. Psychologists I have spoken to will often use the term rumination to describe this process. When you ruminate on something, it means that a particular thought will circle around and around in your mind, progressively getting more and more exaggerated, the more and more you think about it.

Everyone has experienced this at some stage. You may have had an argument with a friend, family member or colleague and subsequently not been able to get the subject of that argument out of your mind. You may find yourself frustrated initially and then the more that you think about it, the more and more annoyed and angry you become. Whilst this is a perfectly normal occurrence, for many people it is something that happens occasionally, not frequently. For a person with anxiety it something that happens almost daily. Because sufferers of anxiety have difficulty regulating their emotions, when they become fixated on a particular thought or feeling, this can escalate out of control very rapidly, resulting in them losing the ability to focus on anything else. Emotional regulation also affects positive emotions such as love or happiness and can cause you to experience extreme highs. This is one reason why people with a mental illness can often make bad decisions around relationships. Often however, anxiety and emotional regulation problems present most strongly with negative emotions like fear, anger and frustration.

Getting back to my little episode in Bangkok, what started as a couple of simple concerns around whether I would be able to find the right platform and get to my connecting train, rapidly escalated in my own mind to a catastrophe. I was going to find myself lost in a foreign country, unable to get from A to B. I was going to miss my train, not be able to get my destination, which would cause me to forfeit my accommodation and subsequently my entire trip would be ruined.

The Emotional Merry Go Round

When you suffer from anxiety or other issues with regulating your emotions, normal thoughts and fears quickly spiral out of control. It’s like being on a merry go round that is gradually going faster and faster. It’s not just that you can’t get off, which would be the smart thing to do, but you're so caught up in the moment you don’t even realise you’re on the ride in the first place. This analogy explanation helps to explain why many treatments for anxiety will focus on some aspect of mindfulness. Mindfulness is one way of inserting a circuit breaker into the system to allow you to realise what is happening and bring you back to reality.

For the record, the trip across Bangkok was incredibly easy, I made my train with plenty of time to spare and the disasters I had been imagining stayed where they belonged, in my imagination.

A Model of Anxiety

The thing about anxiety is that it doesn’t just strike when you’re travelling our foreign city in a country where you can’t speak the language. It affects you in one way or another every day. People who suffer from anxiety are overly sensitive to the actions of those around them. They are likely to falsely interpret other people’s behaviour and blow out of proportion relatively simple day-to-day social and professional interactions. The diagram below shows a very crude model of this.

The diagram shows a series of relationships for a fairly typical individual. We all experience conflicting pressures on our time from our family, our friends, our work and a variety of other social influences. For many people managing these is not always easy, but is also not a daily chore. For someone with anxiety though, who lacks the ability to regulate their emotions correctly, the impact of these interactions can become extremely challenging. Because of the tendency for someone with anxiety to ruminate on the behaviour of both themselves and others, and to overreact emotionally to pressures that are placed upon them, circumstances which may be relatively routine for a mentally healthy individual, can rapidly escalate into an out-of-control situation for someone suffering from mental illness.

This can manifest itself in a number of ways. One is for the anxious person to create narratives to fit the actions of others. In the above diagrams, most of the actions are occurring independently of each other. Your friends want to see you, your boss needs you to work extra hours, you mum is complaining that you don’t call home enough. Each of these are pressures on your time, but the people placing these pressures on you are likely thinking more about their own circumstances than they are about yours. Rather than consider the situation in these terms however, the anxious individual will build a story in their mind to explain these interactions, and it usually a negative one.

• Its not that my friend cancelled our night out because they were tired after a big week at work. They cancelled because they were annoyed at me because of some thing that did.

• My boss isn’t asking me to work back because he’s under the pump from his boss and really needs to meet a deadline. Its because he’s a jerk who doesn't understand how hard I find this.

• When I ring someone and they don't return my call it's not because they are really busy and have a lot on their plate. Its because they are lazy, or incompetent or are deliberately ignoring me .

All of the above examples share something in common, which is the natural tendency of someone with anxiety is to imagine conflict where none exists. For someone who already suffers from an impaired ability to cope with social situations or interactions, this is a real drain. Its also the start of the cycle of negative thoughts that can cause their mood to spiral out of control.

What Can We Take From The Above Observations?

Firstly, if you are someone who suffers from anxiety, understanding how your thoughts work can help you to keep them under control. Most treatments for the symptom of anxiety I have described rely on some form of mindfulness activity. Whether it’s a simple act, like taking a deep breathe and counting to ten when someone does something that frustrates you, through to a deep meditation activity, all of these activities are designed to insert a circuit breaker into your thought process that is starting to spiral. They are designed to force you back to reality and ground you there.

Secondly, we can pause and think before jumping to conclusions. Maybe the guy who just cut you off in traffic isn’t an arsehole, but has his pregnant wife in the passenger seat and is racing her to hospital as shes gone into labour. You'll most likely never know, so don't assume the worst.

Related to the second point is focusing on those things you can control. Even if the guy who cut you off really is an arsehole, there’s not much you can do about this. Ruminating on it is only hurting you. Its not having any effect on him. Letting your moment of frustration pass and getting on with your day is honestly the best thing you can do. When it comes to these types of situations there is a lot of truth in the old saying:

The best form of revenge is living a good life

Even if you don’t suffer from anxiety, you can still benefit from some of the suggestions above. Most people enjoy chilling out in some form or another. Chilling out is just another way of saying you want to relax and let go of the things that are bothering you. Keeping the above points in mind might help you to chill out a bit more often.

You can also pay special attention to the second point about not jumping to hasty conclusions. In America, it is estimated that 18% of the population suffer from some form of anxiety disorder. That’s almost one person in five. If you don’t suffer from anxiety, then chances are that someone you know does. Next time a friend or colleague is behaving strangely, try to cut them some slack. Worst case, you’ll stop yourself getting frustrated about things you cant control anyway. Potentially though, that person is dealing some stuff that you aren’t aware of, and a little but of understanding might be all they need to get through the day.

If you would like to know more about anxiety, here is the article that I referenced above that has some useful information.

8 Facts About Anxiety Disorders

If you would like some suggestions about how to better manage your anxiety the following two articles provide some tips.

ADAA Reviewed Mental Health Apps

Self Help for Anxiety

Photo's by Jad Limcaco and Jared Rice on Unsplash

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