Anxiety

I have seen a lot of anxiety recently. Two bright young women and one bright young man are all going through things that create a crisis of anxiety in them that can sabotage their daily lives. Of the fifty or sixty people I hold some kind of a brief for, most of them (more than three quarters) are subject to a level of anxiety that is sometimes quite debilitating. A significant amount of them would probably name anxiety as the worst thing in life at the moment.

It stops them from taking action (and yet action is the way out of anxiety), stops them from thinking straight or conducting a reasonable conversation sometimes. Sometimes it stops sleep and eating, and certainly erodes confidence and enjoyment. Strangely it also seems to be self perpetuating in that it prevents action that would reduce the anxiety itself, and in that way is seems to be like a thought virus that gets in under the radar of the immune system.

I try to adhere to the principle that whatever is going on the brain and body has some useful purpose, but I find it hard to see what that might be with anxiety. It seems to me to be a self feeding system, a little like a hurricane in full flow that gathers energy into itself as it storms its way forward. It lives off fear of what might happen, feelings of powerlessness in the present and ‘look what happened last time’, takes you away from the reality of choice and consequences and into fearful fantasy, so that your mind is sent spinning into a future so awful it holds your attention while the rest of your consciousness is disconnected from the grid.

I can suggest that possible payoffs for this might be that you can excuse yourself from taking responsibility for hard choices here and now, and that assessing risk is a good thing, I can also see that this out of control thing is fundamentally unhealthy, and that seeking its positive intention is about as helpful as seeking the same from cancer. And of course it also has to be noted that anxiety creates stress, a killer in which heart rate and blood pressure rise (in the case of at least one of the three noted above it virtually doubles).

Simple in principle to knock it on the head – come back to the here and now, breathe deeply and slowly, consider choices, assess the likelihood of the more obscure risks, take some positive action, but all these actions are extremely difficult to do if you are suffering from anxiety at the time. Also, they are short term answers that will remediate the immediate symptoms, but not really solve the longer term problem.

Two features of Asperger’s that may be relevant here are the weak executive function that some say goes with Spectrum Disorders, and low self esteem, which frequently seems to accompany Asperger’s.

Weak executive function may be a contributing factor to the notable reluctance of people with Asperger’s to get to grips with midterm strategic steps towards their goals. When I am with someone in the midst of an experience that cannot quite be called a panic attack, but which seems to me to be veering in that direction, and I suggest breathing, re-focussing etc – all the cognitive and behavioural avenues I mentioned above – they get dismissed as not effective. I want to tell people to ‘get a grip’ and it is that which seems very hard for them to do.

Low self esteem is perhaps easier to see – ‘I can’t do that’, ‘it’s all right for you to say that!’, ‘it won’t make any difference anyhow’ are all signs to me that self esteem could be higher. So a longer term strategy for supporting anxiety reduction is to attempt to raise self esteem by taking the situation very seriously, acknowledging the feelings, maximising empathy, and making that person highly important to you.

In as much as anxiety is created by specific peptides released into the blood – and this is probably more true then we think - then it can be remediated also by medication, and although many people resist medication, the chance of life without this debilitating condition is worth taking. Medication is useful if it works, and it often does. Sometimes it does not and with the spectrum population it can be quite contrary, but it should not be dismissed out of hand.

I am not trying to produce answers and panaceas, but only to note that anxiety is a thing that can have very real consequences and be so difficult to live with that it can often prevent the person from adopting remedies. Not easy.