During the last 7 years Dr Verne Kallejian wrote over 15 articles for HealthandAge.com. As a practicing psychologist, he was able to express complex emotional concepts in terms that were readily undersood by our visitors. Verne died, after a long illness, on January 12 this year. As a tribute to our friend, we are re-posting one of his earliest pieces, "Why Do I Get So Anxious?" Robert Griffith, Content Editor.

Introduction

There is no human emotion that is potentially as devastating and disabling as anxiety. Unlike real fear, anxiety is fear without a known cause. It doesn't mean that the anxious person can't say something about the discomfort, but it is never an adequate explanation for the irrational fear.

Fear is an important emotion. It mobilizes the resources of the body to deal with danger. It focuses attention on the source of the fear and activates the intellectual resources to make rapid decisions to avoid a real danger. Fear is like a burn response. It tells you to pay attention to danger. This response to danger is inherited and probably comes with the package at birth.

What is the fear response?

Many, many generations ago one of ancestors turned a corner and faced a saber tooth tiger. Immediately, a portion of the nervous system prepared the hunter for danger. Adrenaline was released and sugar was discharged into the blood stream. His pupils dilated and his vision became more acute. The hunter could now move more quickly and run faster and longer if required. The blood vessels in the outer body contracted forcing blood towards the center of the body and the body hair stood on end. These reactions provided a little protection from being wounded and also slowed bleeding in the event of an injury. This hunter had a better chance of survival than others who did not have these protective responses. As a result almost everyone you and I know has elements of the above responses to danger - real or imagined. Fear that has become anxiety often feels as if a saber tooth tiger is lurking somewhere in the area all day long and we can't find it.

How does fear become anxiety?

Most sources of fear develop early in life and persist through adulthood. In childhood many stimuli cause fear and the response persists even though the exact nature of the stimulus is forgotten. For example, when parents fight small children often imagine that their parents might kill each other. Children become extremely fearful that they will be left alone and die. If this occurs often enough, they associate this fear with their parent's anger, and eventually with any episodes of anger. The fear of anger becomes deeply buried in the child's psyche and persists into adulthood. Our adult may never connect the fear of anger with the events around parents fighting. If the connection is made it is quickly forgotten because it is so irrational. Nevertheless, the adult would have a major anxiety burst when watching a violent movie or when exposed to anger. The psyche makes the connection even though there is no conscious awareness of the historical events.

It is easily seen that anxiety is a devastating emotion. Unlike fear, anxiety has a disintegrating effect on the body. The intellect keeps searching futilely for a cause that can be addressed, and finally gives up in exhaustion. While fear mobilizes the resources of the body, anxiety has the opposite effect; the intellectual resources are scattered. Anxious people find it hard to relax, sleep, or even carry on a discussion. They become irritable and jittery and search frantically for some form of relief from the devastating feelings. They may leave the situation that produced the anxiety only to find that it still persists. If the anxiety is free floating, then events that cause most people only little concern (like driving on a freeway) can cause the anxious person to experience a high level of anxiety, and such a person may avoid them altogether. Free-floating anxiety can attach itself to almost anything that would be only of casual concern to most people. Events like flashes of lightening, imagined loss of a spouse or family member, a threat of a flash flood, and even the imagined potential of having a life-threatening disease can cause endless anxiety.

The withdrawal response, as demonstrated in one of Pavlov's early experiments, can perpetuate itself indefinitely. A dog was placed in a room and presented with a white rabbit. When the rabbit appeared an electric shock was administered to the dog's foot. Of course, he lifted his foot. After a few repetitions the dog not only lifted his foot when seeing a rabbit, but also had the same response when seeing anything white or furry, or having a long ear. Actually, the dog took no chances - he would raise his foot when he saw anything that reminded him of a rabbit. He was very relieved to have avoided the potential shock that was a reward for this response. The dog would keep this up for a lifetime. Humans sometimes have this response. If past history has taught us not to trust affection because there was injury, hurt, disappointment, manipulation, or bad feelings, then we reject it. The adult will then turn from any situation that has affectional overtones with considerable apprehension. This response can persist for a lifetime.

There are hundreds of such events from childhood that pervade adult life. Unless we are well defended against anxiety the only safe place is in a bed or a closet. Indeed, there are some people who never leave their home.

What protects us from anxiety?

Imagine that there is a thick puncture-proof mattress in your head that sits right on top of all your buried potential anxiety. Occasionally, some event may stimulate enough anxiety that it penetrates the mattress. A person will feel anxious for a brief period of time and then the mattress will seal itself again. Almost everyone can live with this brief discomfort. Being productive, having friends, keeping fit and having a rewarding lifestyle keep the mattress in repair.

If these positive activities should begin to diminish, the thick mattress might become very thin and will have no more protection then a piece of wet tissue paper. Now, if anxiety develops, the tissue paper just falls apart and the individual is in some form of an anxiety state. If being productive (e.g. going back to work) has helped in the past, the individual starts trying to do things that are personally rewarding. Generally this starts to build up the mattress again and the person feels a little better. This process of breakdown and repair can go on for a long time.

There is a point at which being productive takes more energy than is available, or, repeating the same productive actions no longer relieves the anxiety. At this point the system, which has worked for a long time, begins to fall apart and the person becomes overwhelmed with anxiety. This process is called decompensation, and the result is so devastating that some kind of professional intervention is required. Some people know they are anxious most of the time. Others never identify anxiety and just complain about headaches, backaches and heartburn. Others are anxious all of the time. The rest of us fall in between. There are several common types of anxious states. The most common is a generalized anxiety, as discussed above, and is characterized by excessive worry and tension. Sometimes a situation or an event will cause an intense burst of anxiety, which is experienced as panic (generalized sudden fear together with various physiological symptoms). Sometimes the anxiety is focused on one stimulus, such as driving on a freeway. Phobias of this nature can be focused on almost anything. Some folks can't go to dinner without sitting on the outside of the booth. Other folks can't stand being above ground level. For them, it's difficult to find a physician, lawyer, etc. who all have offices at ground level. A most devastating anxiety state is when there is a repetitive intrusion of unwanted or disturbing thoughts. This state is often associated with a powerful need to keep very active. Folks with this kind of obsessive-compulsive disorder have a strong need to keep things orderly. Some people clean their home many times each day. At work, people become excessively concerned with the progress of their activities and constantly question subordinates, request frequent reports, cannot stand a speck of dust on their desks and may wash their hands thirty or forty times a day.

People who have had little exposure to psychological understanding usually attribute anxiety disorders to some kind of physical disorder. And, there are usually enough physical symptoms to support this notion. That is why many physicians often have a difficult time diagnosing an anxiety disorder. Patients who have little understanding of anxiety may resist the notion that they have an emotional disorder, and seek some other form of intervention.

What to do about it

The most important first step is to rule out physical disorders that can cause the symptoms of anxiety. This involves a visit to a primary care physician and possibly some testing. Once it is clear that their symptoms have an emotional cause, that itself is already some comfort for most people. At least, you now know the real problem. There are many pathways which people take to deal with anxiety. Some, although not as many as you would think, find that alcohol is a rapid acting, easily available tranquilizer. Others resort to overuse of medication. There are many wonderful medications on the market, which tranquilize and reduce the discomfort of anxiety. If your physician makes such a recommendation, it is worth trying. Some people just go to bed and stay there. Others try a regular exercise routine. All of these efforts help in different ways. None of them, however, attacks the basic sources of the anxiety. Since the basic sources of anxiety are not immediately accessible, depending on the severity of the symptoms and the extent to which they interfere with daily living, some steps should be taken to get some insight and understanding of what is happening. The first step is to start talking about it to family or friends who can listen to you with caring. It is even better if you can find someone who has themselves been through some kind of Anxiety State.

Some folks start to keep a diary of the events of the day with particular attention to what relieves or causes anxiety. People with such diaries frequently find patterns that add to understanding. People who keep diaries often share the contents with each other.

In some communities there are small groups of people with similar symptoms who get together and discuss their problems. For many people this can be very helpful. It is commonly accepted that there are three accepted approaches for the specific treatment of most anxiety disorders. One can take a course of one of the highly effective medications on the market. A second approach is to get some detailed explanation of your specific anxiety and then some direction on how to change your behavior in a way that will reduce or remove the symptoms. More commonly people pursue a course of treatment with a trained therapist. In my experience, medication with some form of psychotherapy treatment is the most effective. But, this approach is not for everyone. Each person must discover for themselves what kinds of activities or thinking reduces the discomfort of anxiety.

Where do we go from here?

Early in this article mention was made of the flight response. Any discussion of anxiety must include the connection between anxiety, aggression, anger and depression. The most critical connection is that either some internal thoughts or external events that cause some kind of threat can also elicit anger. When anger is not dealt with in an adult way, then a person can easily become depressed, anxious, and irritable. These relationships are so complex that abstract discussion becomes almost meaningless.

We recommend that you read more of Dr Kallejian's articles. See the first link, below.