It was Mother’s Day in the US, but I was in London. My daughter lives there and did all that she could to make it a special day for me, and she did a wonderful job. The thing is many holidays are bittersweet these days, and this one was, particularly this year. My Mom passed just about a month ago and Sean passed just 2 years ago. They are buried next to each other on the same hill in Atlanta, along with my Dad. Sean was very, very close to my parents, and so it is fitting that they spend eternity next to one another. A day that’s supposed to be a tribute to me as a Mom, brought me to tears right in the middle of an upscale, waiting- line-outside restaurant that my daughter picked out especially for me. Somehow, without my Mom to call and without Sean to call me, it was still sad. There is much that links my mother and Sean, one of the most significant being anxiety. I have spoken before about Sean’s social anxiety, and the fact that it is a frequent partner to bipolar disorder. I have not discussed in any detail what anxiety can do to your life largely, because I didn’t appreciate it until this last year. To me, it’s a demon that eats you from the inside out, warping your perspective on yourself and the world. It can be crippling to the sufferer and exhausting to their family and caretakers. Different from the everyday anxiety that each of us has experienced (e.g. I date new date, your wedding day, etc.) an anxiety disorder is constant, unsubstantiated and is an impediment to our daily existence. Unlike everyday anxiety, this takes feeling awkward about a social situation to avoiding social interaction for a real fear of being embarrassed or judged. It exaggerates the sweating one might have before a big test, or the jitters of getting married to a panic attack. It’s irrational fear, excessive or compulsive behaviors that must be repeated, possibly with nightmares or inability to sleep due to worry. These emotional symptoms may be accompanied by physical symptoms as well: irritability, muscle tension, inability to sleep, headaches, etc. This disorder may affect 6.8 million people or more in any given year, more often in women, and can begin at any point in one’s life. The causes aren’t really known, though genetics and environment are connected in some way. (See http://www.nimh.nih.gov for more information)Why am I spending so much time on this? Because in the past year, I have seen anxiety that was so severe that it crippled someone I loved. It changed who they were and how they saw others, and it exhausted those charged with caring for them. This person went from a relatively independent, very bright individual to one who couldn’t handle the slightest stress or issue. Witnessing the decline of self-reliance, self-esteem and the increased frequency of panic over such things as having to wait in a doctor’s office was extremely sad. The amount of energy spent answering phone calls about things which seemed blown so far out of proportion was incalculable. In the end, there was an ever widening circle of approach avoidance, where the caretakers would avoid contact with the anxious person, which would increase their anxiety and need to connect. During this time, many medications were used to try to control the level of anxiety, which was increasing exponentially with any new stress (physical illness, payment of a routine bill, etc). In their case, nothing was strong enough to give relief to the benefit of any involved party. Finally, a mood stabilizer was introduced, as it was determined that this individual had a mood disorder (perhaps bipolar disorder) and finally, the relief that was remarkable. Unfortunately, it came too late in the progression of this person’s physical illness; nonetheless, it did give the family a chance to relate to their loved one in a way that reminded them of the person living inside the prison of uncontrolled anxiety.I, myself, have never really been an anxious person, although recently, the odd feeling that something is wrong that you can’t put your finger on, where your stomach feels queasy and you are unable to really think clearly, has hit me on occasion. Sometimes I can recognize the cause; other times I have no clue what the trigger is. Anyway, I’ve never been terribly tolerant of people who seem nervous for no apparent reason, or who need a lot of support just to get through normal ups and downs of life. My perspective on this is so, so much different now. I now can see anxiety as a serious impediment to living a normal life; something that can happen to anyone.My ignorance and intolerance have been challenged by this experience, as well as the love I have for other people who are very close to me who suffer with serious anxiety disorders, some chronic, others acute. I’m talking about brilliant, lovable, high functioning people who struggle to overcome panic and inexplicable anxiety to get through the stresses of most days. While there are options for treatment of anxiety, many times it includes drugs that are potentially addictive. Often the anxiety is accompanied by depression, and so SSRIs are introduced along with short-term use of anti-anxiety drugs, such as Xanax and Klonopin. When anxiety is part of the bipolar disorder symptoms, however, SSRIs only exacerbate the symptoms which is why mood stabilizers are used instead. (This is an important piece of information. If someone you know is on an anti-depressant and their anxiety seems to be worsening, or not improving, consider the possibility that they are bipolar). Unfortunately, depending on the extent or cause of the anxiety disorder, mood stabilizers may not be enough, leaving room for much needed research.In addition to medication, Cognitive Behavioral Disorder is a psychological intervention that seems to yield significant improvement. In a nutshell, the intent is to train a person to recognize the trigger for anxiety and learn to respond in a healthier fashion. Of course, there are many other approaches to psychotherapy, but this seems to be one that gets universal acceptance.I cannot ever explain the anxiety that I have witnessed in the last 18 months or so. It was so very sad as well as unbelievably challenging for caretakers. I can only say that if you or someone you know has recurrent or persistent anxiety, there is help and definitely hope. There may be trial and error with treatment protocols, but a solution is possible. I would highly recommend tracking your moods on www.moodtracker.com. It’s an invaluable tool for you and your clinician. I just want to reiterate the importance of identifying any history of bipolar disorder in your family while considering treatment for anxiety. You are your best advocate. And finally, have empathy for the families. Anxiety disorders can be very, very taxing on everyone in the sufferer’s world.
In memory of Antoinette T. Kurz (1930-2010)
Mom, I miss you everyday. Take care of Sean for me.