Anxiety and depression are now being spoken of more openly than ever before. Stories offering first hand experience of these conditions and the effects on sufferers and their families, statistics about the percentage who are affected and encouragement to talk more openly are hitting the headlines more often. However many still feel silenced by their adverse mental health condition and understanding lags behind.
Many images have been used to describe why we become anxious and how it fits into our fight or flight response. One of my favourite metaphors is that used by Nadine Burke Harris in her TED talk (How childhood trauma affects health across a lifetime – TED.com). In it she describes how our stress hormones are affected by perceived danger. If you are walking in the woods and you encounter a bear your fight or flight response is triggered. The brain pushes everything aside to focus on the threat. Adrenaline and cortisol are released, our heart pounds, our breathing changes, we are hyper vigilant, watchful and aware of any potential escalation of our peril. We are ready to respond to the danger; flee or confront. Once the incident passes and safety is achieved our brains and bodies stand down, our stress chemical balance returns to normal.
When children live in unsafe circumstances, exposed to abuse, neglect or aggression their fight or flight response is triggered. Similarly children facing bullying at school have to deal with meeting a constant threat. For some there may be a single event which is so traumatic it impacts in a lasting way on their sense of personal safety and the security they feel in the world they live in. These children aren’t navigating occasional encounters in the woods. They are living with the bear.
So what happens when this is your life from a young age? The fight or flight response stays switched on, there is no stand down, it feels as if the danger is ever present or possible. The mind and body adapt: stress and worry become a way of life and if nothing changes the outcomes can be harsh. Children develop a maladapted system of stress which can rise and peak on a hair trigger: at the same time they try to manage this response and the misery it brings. As they grow this can manifest as adverse mental health conditions, such as anxiety and depression, which carry on into adulthood.
Anxiety evolves from being watchful and on full alert for signs of danger; initially in the abusive or insecure situation, but then in other areas of life. Already carrying high levels of fear and anticipation, any additional stress becomes difficult to manage. The difference between worry and panic narrows, the response can take on many different appearances, sometimes it is withdrawal, sometimes overconfidence, sometimes anger, sometimes something else, but always it is based in fear. Life can become dominated by 'what ifs'. And these are never about something going well but the most calamitous of outcomes in any given situation.
Where does depression arise? In how children try to make sense of their world. They are egocentric and try to understand their lives through themselves. Something terrible is happening, I may feel better if I can control it, this must be my responsibility, maybe I did something, maybe I am not good enough, maybe if I try harder? That questioning voice can turn on the individual and morph into the bullying voice of depression: pervasive low moods, lack of motivation, fear, self criticism and internalisation of blame. The bear has taken up residence.
Does this always happen? Of course not. Some of us are born more resilient than others. Life can change and get better at the right time for some to bounce back. Strong relationships based on love and acceptance can make an important difference. A change in environment, effective support and greater understanding, all can have a positive impact. There are also interventions that can lead to improvement. As a therapist I have worked with some of those who have been less able, for a range of reasons, to successfully negotiate this struggle alone or have had to manage life situations which sent them back to a place they thought they had left.
It often seems to those who suffer anxiety and depression that they develop these conditions in adulthood and while this may be true for some: for others the roots may go deeper. The link between the present and the past may be totally obscure and seem irrelevant. To any of us who have managed life successfully no longer being able to do so can seem inexplicable. Medication may be suitable or enough for some, for others working to understand themselves and the basis of their issues may the better option. This doesn’t have to be an either/or choice, therapy and medication can be utilised successfully, in tandem.
Working with a trained, professional counsellor can enable those suffering from anxiety and depression to navigate a different way of living. While Cognitive Behaviour Therapy offers tools to reframe and manage thoughts and behaviours, Person Centred or Psychodynamic therapists invite a deeper exploration and understanding of these conditions and their origins. Integrative therapists, such as myself, may offer both CBT and Person Centred/Psychodynamic ways of working.
As with any adverse mental health condition many of those living with anxiety and depression do so unknown to those around them. They find ways to manage. This may involve, for example, developing a persona to get through difficult situations or avoidance of certain events, people or places. As I say to my clients this is not cowardice it is defiance. Your brain tried to make sense of an impossible way of living and this is where it ended up. But you survived. Now let’s think about how you would like to live and work on getting there. It’s time to leave the bear back in the woods and move on.
Photo by Annie Spratt