Facing the Demons of Chronic Anxiety
The word recovery has always frightened me when it came to my own mental health. For years I’ve asked myself, how exactly do I recover from something that is with me for the rest of my life?
My anxiety can overwhelm me when I’m trying to sleep. Sometimes, as I’m about to drift off, I imagine a person is hovering over me. Although I’m fully aware that no one is actually there, my hands start to sweat and my feet turn to ice. A feeling of nausea builds until I’m about to vomit. If I try to stand up, my legs may collapse like cooked spaghetti. Other times, my anxiety sends me lurching out of bed to vacuum imaginary spiders from the corners of my ceiling.
When I was 17 and first realized that I had a mental illness, I spent the entire next year in complete denial, telling myself that one day I would wake up and the anxiety would have vanished — that I would forget I ever had to suffer from the voice in my head telling me that with every step I take, I will die. But after waking up over hundreds of mornings to find that my irrational fears were still with me, I realized this wasn’t going to change overnight.
That wishful thinking as a teenager only made my situation worse, especially when it came to my unorthodox methods of self-care. I left scars on my arms from both cigars and razors. I started to drink in the morning before school, and I took any prescription pill that I could find in my parents’ medicine cabinet, only to find myself now becoming physically ill as well.
All these negative behaviors were attempts to ward off the pain. And throughout my early 20s, I remained optimistic that I would someday find a simple cure for my anxiety, but reality wouldn’t set in until I received the greatest advice ever given to me — advice that would end up saving my life.
I left scars on my arms from both cigars and razors. I started to drink in the morning before school, and I took any prescription pill that I could find.
By the time I was 29 years old, though I was married and had a job, I was spiraling out of control. I was drunk every morning before work, and my marriage was failing. I was in the darkest depression. I had seen many therapists, but they all seemed to be telling me what I wanted to hear just to shut me up and shove some medication down my throat.
Searching for mental health answers isn’t easy, especially with the hundreds of different types of medications that are available. On the advice of therapists, I had tried Prozac, Effexor, Zoloft, Xanax, and Clozapine. The Prozac and the Zoloft made me tired all day. Effexor gave me terrible mood swings, horrific nightmares, and erectile dysfunction to boot. Xanax and Clozapine both worked wonders for my anxiety by completely eradicating all my fears. But aside from being highly addictive, their major downside was forgetfulness. Sometimes I would come home and not remember a single thing I had done all day. And then there was the chronic drowsiness: I could fall asleep at the dinner table mid-chew.
One day, I happened to drive by a Red Cross blood donation bus. I associated the Red Cross with needles and pain — but pain always heightened my senses, so I decided to give it a try. I had never donated blood before, and after I entered the bus and filled out the paperwork, there was the option of a 10-minute blood donation or a one-hour plasma donation. I figured the longer that I could sit in this bus with a needle sticking in my arm, the longer I would be able to focus on something other than my anxiety, so I chose to donate plasma. It actually worked. The pinch of the needle delivered just enough pain to quell my angst. Two years later, it had become a ritual of sorts; I was donating plasma every couple of months. It helped, but only temporarily. I only wished the pain would last longer.
When I finally found a cognitive behaviorist, I could immediately tell that something was different. The first thing he told me was that he didn’t prescribe medication. Then, when we started our sessions, he refused to coddle me when I poured my heart out; he just wanted to get to the solution. After a few visits, he sat forward in his chair and said to me, “Ricky, your anxiety is real, and it’s with you for life. You will never wake up one morning to find that it has magically disappeared. Now, when you feel yourself having an attack, just repeat this to yourself, ‘This sucks! But I am not losing my mind; this attack is not real and will only last 10 minutes.’”
I was taken aback by the doctor’s words at first, but my illness of 12 years suddenly seemed to make so much sense to me in a matter of seconds. Still, I was surprised when the mantra the doctor gave me worked — the very next day.
Since just waking up in the morning could be a trigger for my anxiety, as I had to go through the lengthy process of convincing myself that I was real and not stuck in an alternate dream universe, I made sure that I had the doctor’s words memorized so I could be ready. As soon as I woke up, I immediately recited the mantra out loud. In a nervous but confident voice, I said the words he’d prescribed, right down to the part about how it would end in 10 minutes. And it did! My first panic of the morning subsided, and my breathing slowed down. I felt a calm that I had not felt in years.
Despite this seeming miracle, the doctor informed me that it didn’t matter how many positive affirmations I repeated to myself daily, the mantra included; if I was truly going to get better, it was also necessary to work hard to help myself — and the most important thing I needed to do was to love myself above everything else.
Coping with a mental health disorder is a full-time job, and after being diagnosed with generalized anxiety disorder, depression, PTSD, and depersonalization disorder, these are the self-care steps that I take every day to maintain my equilibrium:
Facing reality: Every morning, as soon as I wake up, I remind myself that I have a mental illness, and that it’s not going to magically disappear. My anxiety is something that was manifested in my mind from experiences throughout my childhood. And because I know I will live with this invisible illness for the rest of my life, I must not run from it. I remind myself that today and for the rest of my life, I will live with this disorder, but it is okay. I’ll be just fine as long as I follow the next four steps.
Finding joy: For the empty feeling of depression, I make it a point to find something that brings me happiness. One of my go-to remedies is watching something funny on TV, which makes for an inexpensive and easily accessible self-care fix. For example, a single episode of The Office has brought me back from multiple anxiety attacks and bouts with depression. If it’s a nice day, taking a walk with my wife and the dog works wonders.
Accepting dark thoughts: Whenever I feel anxious, which for me is all day and every day, I use the mantra that I learned from the cognitive behaviorist. If that’s not working, I’ll take three deep breaths and focus my attention on the negative energy that’s plaguing my thoughts and rid them from my mind. Sometimes I just have to remain calm and do my best to remember that I am stronger than my anxiety.
Using natural remedies to sleep better: Trying to fall asleep, let alone staying asleep, might be the hardest and most concerning of all my problems. Each night when I lay my head on the pillow, my mind starts to race with horrible thoughts that have haunted my sleep for years. I’d remember the years of abuse that I suffered at the hands of an older relative who would tiptoe into my room while I was sleeping, hover over my body, and punch and kick me. Years before I got sober, I would easily take four Clozapine pills and wash them down with a tall glass of merlot, but now that I’m sober, I find that essential oils, such as lemon, mint, and eucalyptus oils, work miracles. I rub them on my wrists and chest every night. This way, no matter which position I am sleeping in, I can breathe in the soothing aromas. I also keep a vial of oil in my car and at work. To complement the oils, I keep a humidifier next to the bed to help me stay cool at all times, and I play soothing nature sounds quietly in the background. (Thunderstorms or seagulls usually do the trick.)
Eating a wholesome diet: I used to binge eat to make myself feel better. Nine out of ten times it was greasy fast food or Kit Kat bars. After a binge episode, I would feel terrible self-loathing, of course. About two years ago I made a transition to a vegan diet, and I can’t even begin to explain the benefits that resulted from the switch. I feel healthier than I ever have before, I’m less tired, and my mind is clearer — not to mention the weight loss. Overall and most importantly, my self-esteem and confidence are at an all-time high. Today, I feel proud of myself for committing to a strict diet and lifestyle change, and for the first time since I was a teenager, I feel good about myself when I look in the mirror.
There are many different forms of self-care, and what works for one person might not work for someone else. Maybe medication works for you, and maybe it’s therapy, or both. For me, there are two ways of getting help: the stubborn way and the logical way. For years I tried the stubborn way, which was living in denial, hoping that the anxiety would cure itself.
The lesson I’ve learned is that while life will sometimes seem impossible and anxiety will feel unbearable, as long as I’m willing to put in the work, it will get better. For those of you who have experienced similar feelings, there will undoubtedly be days when you might feel that no one in the world knows what you’re going through. During those lonely moments, just remember that someone just like you wrote this article. If you hit a wall, turn around and try a new route, because at the end of the day, your determination to persevere in life will shine through the darkness. All you have to do is take those first steps to finding happiness.
Be kind to yourself, love yourself, and never give up.
Richard De Fino is a New York-based writer and columnist whose work has appeared in Chickpea Magazine, The Bronx Magazine, and Stigma Fighters, as well as in his former column for Feminine Collective. For more, visit richarddefino.com.
This article is from the November/December 2018 issue of The Saturday Evening Post. Subscribe to the magazine for more art, inspiring stories, fiction, humor, and features from our archives.
Opening the Door to Happiness
Psychiatry is at a historic turning point. The profession is finally taking its rightful place in the medical community after a long sojourn in the scientific wilderness. The National Institute of Mental Health reports that one in four persons will suffer from mental illness in their lifetime. You are more likely to need services from psychiatry than any other medical specialty. Yet far too many people consciously avoid the very treatments now proven to relieve their symptoms.
A few short generations ago, the greatest obstacles to the treatment of mental illness were the lack of effective treatments, unreliable diagnostic criteria, and an ossified theory of the basic nature of the disease. Today the single greatest hindrance to treatment is not any gap in scientific knowledge or shortcoming in medical capability but the social stigma.
Though we live in a time of unprecedented tolerance of different races, religions, and sexual orientations, mental illness — an involuntary medical condition that affects one out of four people — is still regarded as a mark of shame, a scarlet letter C for “crazy,” P for “psycho,” or M for “mental.” Imagine you were invited to a friend’s wedding but unexpectedly came down with an illness. Would you prefer to say that you had to cancel because of a kidney stone … or a manic episode? Would you rather offer as your excuse that you threw out your back … or suffered a panic attack? Would you rather explain that you were having a migraine … or were hungover from having gone on a bender?
A few years ago, I gave a talk at a luncheon in midtown Manhattan about mental illness to raise funds for psychiatry research. Afterwards, I circulated among the attendees — smart, successful, and outgoing people who had all been personally invited to the event by Sarah Foster, a prominent socialite whose schizophrenic son had committed suicide some years ago while a senior in high school. They chatted over poached salmon and Chablis, openly praising Sarah’s selfless efforts to raise awareness about mental illness — though none of them admitted any direct experience with mental illness themselves. Instead, mental illness was treated like the genocide in Sudan or the tsunami in Indonesia: an issue highly deserving of public attention, but one quite distant and removed from the patrons’ own lives.
Several days later, I received a call at my office. One of the attendees, an editor at a publishing company, asked if I could help her. It seemed that she had lost interest in her job, had trouble sleeping, and frequently become very emotional, even tearful. Was she having a midlife crisis? I agreed to see her, and eventually diagnosed her as suffering from depression. But before she made the appointment with me, she insisted I keep it completely confidential — and added, “Please don’t say anything to Sarah!”
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From the book Shrinks: The Untold Story of Psychiatry
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Medical Breakthrough: The Viral Link to Mental Illness
Flu, AIDS, meningitis, Ebola, polio, herpes, measles, rabies—the list of diseases caused by viruses is a litany of woe ranging from the merely annoying to the deadly. Every year almost two million people are killed by the human immunodeficiency virus (HIV), and around half that many people succumb to viral hepatitis infections. The economic toll of viral illnesses is nearly as staggering as the human one; flu costs the United States an estimated $25 billion a year, and HIV costs $36 billion. To make matters worse, new viruses continue to appear (see “Virus Hunter” below), often after hiding in animal populations for centuries before moving into humans—as did HIV, avian flu, and severe acute respiratory syndrome (SARS). But while public health officials and physicians focus on the threat of emerging viruses, little-noticed research is implicating these primitive microbes in diseases long thought to have nothing to do with them: mental illnesses.
The notion that “insanity is infectious,” as virologist Ian Lipkin of Columbia University’s Mailman School of Public Health bluntly puts it, goes back to antiquity. As late as the 1800s, the mentally ill were locked away because, among other reasons, they were thought to be contagious. The notion wasn’t completely misguided. Until the discovery of penicillin ushered in the age of antibiotics, a major cause of mental illness was syphilis. But biomedicine is subject to fads and fashion no less than skirts are, and over the last 40 years disease detectives seeking the cause of mental conditions such as schizophrenia, bipolar disorder, autism, and obsessive-compulsive disorder have turned from microbes to genes as the cause. And now, a parade of discoveries suggests that viruses may be the culprit rather than your family tree. The new research indicates that viral infection can affect the developing brain and contribute to mental illnesses even before birth.
At first the evidence for a viral link to mental illness was spotty and inconsistent. Early studies piggy-backed on observations that when mothers suffered an infection during pregnancy, the children who were in utero at the time had an elevated risk of developing schizophrenia. But rigorous studies of whether that link was real produced contradictory results: Some found that maternal infection with influenza increased the risk of a child developing schizophrenia 20 years later, but others did not. Only in the last few years have scientists sorted it out. Instead of assuming that every child who had been in utero at the time of a flu outbreak had been infected, researchers began examining mothers’ blood for the telltale antibodies that indicate a past infection. With that advance, the link became clear: As researcher Alan Brown of Columbia University calculated in a 2010 paper, more than 30 percent of the risk of developing schizophrenia comes from prenatal exposure to the flu virus.
The flu virus is not the only culprit. In 2000, Brown and colleagues produced the first watertight evidence that young adults who had been exposed to the rubella virus (aka “German measles”) while they were fetuses less than three months old had a five-times-greater risk of developing psychosis—including schizophrenia—than their peers who had not been exposed to the virus.
Contrary to expectations, however, it is not rubella or other viruses, per se, that harm the developing brain. That became clear as scientists documented a veritable menagerie of maternal infections able to cause psychiatric and neurodevelopmental illnesses—not only flu and rubella but also toxoplasmosis and genitourinary infections. To their shock, scientists began to find that, although mothers had antibodies to flu in their blood (showing that the mother had been infected), the kids—in utero at the time—often did not: They were not infected with the virus.
So what was happening? It’s not that the fetus becomes infected. Instead, the infection triggers the mother’s innate immune system, the army of molecules that prime other cells to kill the invaders. “It is the reaction of the mother’s immune system to the infection, not the infection itself, that affects the developing brain,” says Lipkin. Specifically, a flood of antibodies and other immune-system chemicals with names like chemokines and cytokines surges through the placenta and into the fetus. “The result may be compromised fetal brain development,” explains Dr. Robert Freedman, a psychiatrist at the University of Colorado Denver Health Sciences Center.
Researchers put the final piece into the puzzle when they exposed pregnant mice to a molecular mimic of viral RNA (viral genes are often made of RNA instead of the closely related DNA). That exposure put the brakes on special stem cells that give rise to new nerve cells (neurons)—not just in the embryo but on into adulthood. Most egregiously, it blocked the growth of a specialized kind of neuron destined for the neocortex, the most advanced region of the brain.
How bad was the damage? The offspring of the virus-exposed mice could not even walk normally, reported epidemiologist Mady Hornig of Columbia and colleagues last year. And, after the mice grew to adulthood, they had other neurological abnormalities as well.
Because the mother’s immune system’s response to infection causes the harm to the fetus, almost any virus is a potential threat to the developing fetus. “The damage to neurons and neural stem cells might not be evident right away,” says Hornig, “but manifests later as cognitive and behavioral problems.”
How bad will those problems become? “The specific result depends on the timing,” says Lipkin. He explains that if neural stem cells are killed by the flood of immune-system molecules (the chemokines and cytokines) before they mature, they will not take their rightful place in the brain’s neural networks. Circuits that are forming at the time of the infection will be most vulnerable, while those already hooked up are spared. In schizophrenia, for instance, there are abnormally low numbers of neurons and incomplete clustering in a particular area of the brain, hinting that something went wrong when these regions were being constructed. The effect of the viral infection may be delayed even into adulthood if a circuit damaged by the cytokine flood is not recruited until that time.
The apparent link between prenatal viral infection and later brain disorders led Johns Hopkins Children’s Hospital to establish in 1998 the nation’s first pediatric research center to investigate links between severe mental illness and prenatal or early childhood viral infections. Last year, Robert Yolken, who heads the Stanley Division of Developmental Neurovirology at Johns Hopkins Medical School, and colleagues reported that in their study of all children born in Denmark since 1981, mothers who had been infected with herpes simplex 2 had a 56 percent greater risk of having a child who later developed schizophrenia.
Although current thinking holds that the mother’s immune response, not the virus itself, is the culprit behind viral causes of mental illness and neurodevelopmental disorders, there may be exceptions. Yolken, for instance, suspects that herpes and influenza viruses (as well as the Toxoplasma gondii parasite carried by cats and other warm-blooded animals) might invade the brain and lie dormant for years before triggering schizophrenia or bipolar illness.
The evidence that viruses can cause psychiatric illnesses and neurodevelopmental disorders does not mean they are the only causes. For example, bacteria can also trigger an immune response, which may explain why strep infection can damage the developing brain, leading to the constellation of tics, obsessive-compulsive disorder, and other symptoms called Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections (PANDAS). Additionally, many mental illnesses are more likely to arise in people with a family history of them, indicating that they are at least partly heritable. But the failure of geneticists to find genes that have a strong effect on the likelihood of developing schizophrenia, depression, bipolar disorder, or autism suggests that genes do not cause these complex disorders the way a single gene directly causes, say, sickle-cell disease. More likely, says Lipkin, genes make people more or less susceptible to other causes of these diseases—including viruses.
Although the research is still new, scientists believe that it is not too early for obstetricians to take the emerging findings into account. The most obvious step is to monitor pregnant women closely for infections—even those that seem mild—because what may be a minor inconvenience to the mother could be devastating to the unborn child. Women should be educated to be aware of when they might have contracted a viral infection and to tell their obstetrician, who may need to treat them more aggressively than is current practice. In animal studies, after pregnant females were exposed to virus genes, the damage to their unborn pups was prevented when the mothers were given nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. That provides a rationale for using these drugs when a pregnant woman contracts an infection, says Hornig. Currently, obstetricians prescribe acetaminophen (Tylenol) for pain relief in pregnant women, but that compound does not have the anti-inflammatory effects needed to turn off the cytokine flood.
The old expression “take two aspirin—or ibuprofen—and call me in the morning” never had so much meaning.
The next deadly scourge—and where it’s most likely to originate.
It is no coincidence that the most widespread and dangerous viruses began infecting humans some 11,000 years ago, says virologist Nathan Wolfe, CEO of Global Virus Forecasting (GVF) Initiative. When animals and people live in close proximity, as they began to do with the advent of agriculture and animal husbandry, viruses from the former can jump the species barrier—as did HIV/AIDS, Ebola, Marburg, and more kinds of flu than you can count.
Wolfe, who founded GVF in 2008 and has been nicknamed the “Indiana Jones of virus hunters,” warns that our fellow mammals aren’t done with this problematic sharing. Some 60 percent of emerging viruses—that is, those new to medical science—come from animals. And as the world becomes smaller and more connected, allowing a traveler to get from the deepest jungles of Africa to London or New York or Tokyo in less than a day, the chance of a virus jumping from a monkey to a bush meat hunter to a western tourist and the entire developed world has soared. In his upcoming book The Viral Storm: The Dawn of a New Pandemic Age (to be published in October), Wolfe argues that this has made us sitting ducks for another global epidemic.
The greatest threats come from two sources: completely new viruses (such as HIV/AIDS) and viruses that mutate. Primates are the most likely reservoirs of the former because the closer the evolutionary relationship, the more likely a virus is to cross over. (For example, there are no cases of viruses jumping to humans from fish or insects, says Wolfe.) But viruses from mammals other than primates can also spread through the human population like wildfire. The H1N1 virus from pigs was so highly transmissible that it went from infecting zero percent of the human population to 10 percent in only a year, notes Wolfe, killing some 20,000 to 30,000 people. The only reason its toll has not been greater is that transmissibility and lethality are inversely related; that’s why Ebola, though deadly, is not highly transmissible.
An even greater threat is mutation of existing human viruses. If one that is deadly but not very transmissible or very transmissible but not deadly acquires genes for that second trait, the results could be catastrophic. That is most likely to happen when viruses from widely separated regions come into contact—as is more and more likely in what Wolfe calls “this viral mixing vessel” caused by global travel.
“Viruses aren’t static,” he says. “They change over time; they exchange genes with other viruses, which can make them more likely to develop deadly recombinants. The greatest threat is probably something we don’t even know is out there.”