Bruce Alan Kehr, M.D. is the Founder and President of Potomac Psychiatry, ranked “Best Psychiatry Care Provider in Maryland” in 2020 by Global Health & Pharma. He has been named a Washingtonian Magazine “Top Doctor” for each of the past eight years. Dr. Kehr is a best-selling author whose works have been read by over 800,000 people in 206 countries. In 2020, Dr. Bruce Kehr’s blog was ranked #2 in the nation among mental health-related blogs. Dr. Kehr’s book, Becoming Whole: A Healing Companion to Ease Emotional Pain and Find Self-Love, is an Amazon Best Seller in the self-help categories: Happiness, Counseling, Healing, and Self-Esteem.
Faces along the bar
Cling to their average day:
The lights must never go out,
The music must always play . . .
Lest we should see where we are,
Lost in a haunted wood,
Children afraid of the night
Who have never been happy or good.
According to Lewis & Clark College president Barry Glassner, a leading sociologist and author of The Culture of Fear, “Most Americans are living in the safest place at the safest time in human history.” So why are so many Americans, among them many of the new patients coming in to see me, feeling so anxious?
There is a question that comes up increasingly often with those who first set foot in my office. As they begin to explain what’s troubling them, they ask me in a quiet voice—“I am so distressed by what is happening to our political system. It fills me with anxiety, with dread. So…am I normal?” It’s a hard question for them to ask, because many are afraid to know the answer. When it comes to our inner lives, what is normal? And what happens, people wonder, if I’m not? For those who feel unsure of themselves in this regard, the Information Age in which we live can be somewhat intimidating: Just type any symptom or question of mental fitness into Google Search and millions of answers will pop up. Some are well-reasoned, but many more are hyperbolic and intended for shock value. It’s true that in this day and age, we must be careful not to catastrophize problems that may in fact be minor—but it’s equally dangerous to talk ourselves out of finding solutions to issues that can, over time, greatly diminish our quality of life. When it comes to determining what’s normal versus what’s not, anxiety can be a tough ailment to measure. In this season in particular, many of my readers may be feeling the constant low hum of anxiety from the daily uproar in the national press; and as their children head back to college following winter break, await university acceptance letters, or begin their final semesters of their high school or college years. Some anxiety is normal—and even motivating. But for many, dear reader, chronic anxiety can erode one’s confidence and quality-of-life, and trim years off one’s life expectancy. So how is one to determine where they fall on the spectrum? Let’s explore further.
Anxiety is an inevitable experience in everyday life, and a certain level of anxiety is normal. “Signal anxiety” alerts us to an upcoming challenge (for example, a presentation to one’s colleagues at work, or an upcoming trip to tour colleges with one’s child); and mobilizes an increased energy level and sharpens our focus, to assist us in getting the job done. Signal anxiety facilitates improving our performance, and therefore does not warrant evaluation and treatment by a psychiatrist.
However, excessive anxiety may have deleterious effects on one’s health if it goes untreated. This anxiety may be expressed through increasing levels of generalized anxiety, anxiety attacks, panic attacks, the development of phobias, or obsessive thoughts or compulsive behaviors. When threatened, we are genetically programmed to respond with the “Three F’s” – Fight, Flight or Freeze – that are basic human reactions to perceived or real danger in our environment. This response results in a surge of anxiety. With sufficient frequency and intensity of experiencing emotional and/or physical threats, an anxiety disorder may develop in vulnerable individuals.
For example, a large-scale study demonstrated that anxiety in middle aged women resulted in a 77% increased risk of premature death over a ten year period. 5 investigators from Tilburg University in Holland reported in the Journal of Clinical Epidemiology that in a 10-year follow-up study of 5073 healthy women aged 46-54 years, anxiety was associated with a 77% increase in mortality risk, particularly in those with a cardiovascular cause of death. At follow-up, 114 women (2.2%) had died. Lung cancer (23%), cardiovascular disease (18%), and breast cancer (15%) were the major causes of death. The authors concluded that anxiety did predict premature all-cause and cardiovascular death in middle-aged women, after adjustment for standard risk factors and depression.
Other studies show that anxiety, particularly resulting from the two types of stress known as learned helplessness and defeat stress cause the DNA in brain cells to produce fewer “neuroprotective proteins.” Learned helplessness results when we are repeatedly subjected to environmental stress where we feel powerless and trapped. Defeat stress develops when we feel repeatedly defeated or “beaten down.” Important neuroprotective proteins such as BDNF and VEGF serve to nourish our brain cells, protect them from injury due to the age-related effects of what is called “oxidative stress,” and enable our brain cells to have higher levels of important neurotransmitters such as serotonin, dopamine and norepinephrine; and higher numbers of cellular branches called “dendrites” that are critical for our brain circuits to function normally. If a genetic test demonstrates that you have a genetic variant of the BDNF Gene, your neuroprotective protein levels may already be lower than average, which may make you more susceptible to the crippling effects of these two types of stressors.
The take-home message is that high levels of anxiety should be evaluated and treated using the Biopsychosocial Model. Evaluation of possible biological causes of anxiety such as genetic testing, a thyroid disorder, psychological factors such as earlier traumatic experiences, and social/environmental influences such as an emotionally abusive relationship at work or at home, can lead to effective treatment strategies. In treatment there may be a role for anti-anxiety agents, cognitive/behavioral therapy including desensitization, and tactics to reduce environmental stressors. Effective treatment has actually been shown to increase levels of BDNF in the brain, and restore a normal number of dendrites to brain cells, which correlates with greater life satisfaction, and improved longevity.
Finally, learned helplessness and social defeat stress can be worsened by repeated exposure to the daily news cycle. As I wrote about in my series Digital Downfalls, your mobile telephone can become a significant source of distress in your life and worsen your performance at work. If you want to feel less anxious and work more effectively, leave it in another room for significant parts of your day!
To read more about how anxiety can affect middle-aged women, and what you can do to prevent it, read “Session 9: How to Recover from Empty Nest Syndrome” from my book, Becoming Whole: A Healing Companion to Ease Emotional Pain and Find Self-Love.