Jog On. Bella Mackie
Freud wrote that ‘anxiety [is] a riddle whose solution would be bound to throw a flood of light on our whole mental existence.’[38] He spent a lot of time thinking about this particular mental-health problem, and initially thought that anxiety had something to do with the trauma of being born. Later he suggested it was probably also about the death instinct or some form of aggression operating within ourselves. Above all, he thought it was connected to the helplessness of infants – who can’t survive without the assistance of other people, creating a trauma that sticks with us. Then again, Freud came up with the Oedipal theory, so I’m shocked, that like Philip Larkin, he didn’t chalk anxiety up to your mum and dad fucking you up.
But despite this wealth of material, anxiety as a stand-alone mental illness was not recognised properly until the 1980 publication of DSM-3, which had a chapter on anxiety disorders.[39] These included phobic disorders, social phobia, panic disorder, GAD, obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD). Wahooo! We were recognised! It’s nice to finally get some recognition … I’d like to thank my family, my friends and my dog.
This stand-alone diagnosis is important – no longer would anxiety be lumped in with other mental-health issues (though of course, many overlap). And that coincided with the introduction of treatments that might actually work. Thank God we now live in an age where medicine is not only effective but also has the added benefit of not being utterly punishing. Not for us the hideous ‘have a bash’ treatments that the mentally ill suffered through the ages – trepanning (having a hole drilled into your head to reduce pressure), lobotomy (which involved severing neural connections in the brain so as to relieve certain severe mental conditions), diathermia (using a current on the brain to jolt patients with psychosis), or being submerged in freezing water to treat women with hysteria. Hysterical women crop up a lot in history – from Hippocrates, who thought women’s wombs wandered (what a band name), to English doctor Thomas Sydenham, who wrote that hysteria was a malady which nearly all women suffered from – ‘there is rarely one who is wholly free from it.’[40] The Victorians were mad for trying to give women orgasms – whether or not they wanted them – to stop women being unhappy or angry, or maybe just not the perfect subservient wives that men expected. Between 1864 and 1889, entries at one asylum in Virginia recorded the reasons that patients were said to have become unwell. These included: laziness, egotism, disappointed love, ‘female disease’, imaginary female trouble, jealousy, religion, asthma, masturbation and ‘bad habits’.[41] Worryingly vague, and although not given as the main reason for admission, they seem hard to disprove …
As an aside, if you want to read more about how women with mental-health problems have been treated over the years, read Mad, Bad and Sad by Lisa Appignanesi.[42] It’s fascinating on the subject of how women are still much more often categorised as mentally unwell or ‘unbalanced’ than men.
The most effective treatment for anxiety is usually agreed to be talking therapy, which many credit Freud with bringing to the fore. His famous description of Josef Breuer’s treatment of the patient Anna O. (later revealed to be Austrian Bertha Pappenheim, the founder of the League of Jewish Women) is widely regarded as the beginning of psychoanalysis. Guess what she was diagnosed with? Yup, hysteria.
Cognitive behavioural therapy (CBT) is now seen as one of the most effective types of treatment for anxiety disorders – and the one recommended by the NHS.[43] Developed in the 1960s by Aaron Beck, it’s a form of therapy which involves re-examining your thought patterns and challenging negative behaviour. CBT is also recommended in the treatment of depression, schizophrenia and bipolar disorder and there is evidence it can help with chronic fatigue, anger issues and sleep problems. Having had therapists in the past who were very keen to start right back in my early childhood and work through my entire life in a bid to find the one key thing that made me anxious, I was relieved to try CBT and cut out much of this process. The first thing I was given was homework – a sheet of paper with boxes on it. In these, I had to write down my big irrational thoughts and what I thought would happen if the worst came true. Sometimes the sheets would look like this:
Huge worry: What if I start hearing voices and believe aliens are trying to abduct me?
Likelihood: HIGH.
Conclusion: I’ll have to live in an asylum and I’ll never see my family again.
The homework then required me to write down the worry again, and then to consider a more realistic conclusion:
Huge worry: What if I start hearing voices and believe aliens are trying to abduct me?
Likelihood: Actually pretty low – in 2014, an estimated 0.7 per cent of the UK population were reported to show symptoms of psychosis disorder. [44]
Conclusion: While there is a slim chance that I might have a psychotic illness, there are many people who live full lives while coping with serious mental-health problems, and very few people end up in what I think of as ‘asylums’ anymore. There would be a plan of action and I would have great support in place.
I was sceptical of such a method – I’d been dealing with catastrophic worries for years; it felt too simplistic to merely write down my worries and try and reframe them. But what do you know? It started to work. I’d write these alternative conclusions and quickly forget them. Later on, when inevitably another new and SCARIER worry cropped up, I’d do my normal freak-out and start falling down the rabbit hole of catastrophe. But then something would stop me – I’d remember the worksheet and ask myself if I could see a different outcome, whether maybe I had a choice in how far I chose to take the thought. I still do this in my head from time to time – when I feel my thoughts racing and have to rein them in.
CBT has worked for me, and for many others who have been lucky enough to receive this treatment. But current NHS waiting list times often mean that medication is offered first.[45] In the course of writing this book, so many people I spoke to were still on the waiting list to have a limited number of CBT sessions, and would take medication as they waited for talking therapy. The medication most commonly prescribed for anxiety disorders is selective serotonin reuptake inhibitors (SSRIs), which are thought to increase the levels of the chemical serotonin in your brain. After carrying a message between nerve cells in the brain, serotonin is usually reabsorbed by the cells. SSRIs work by blocking this absorption, meaning more serotonin is available to pass further messages between nearby nerve cells. You might also be offered serotonin–noradrenaline reuptake inhibitors (SNRIs), which increase both chemicals, or benzodiazepines, which have a sedative effect and can’t be used for a long period of time because they’re addictive. Speaking personally, they’re bloody amazing for a short window where you’re finding it hard to get through the day. But be aware that the doctor will probably not give you more than two weeks’ worth, for good reason. Especially if you go in wild-eyed, praising them and loudly insisting you must have more. Not my subtlest move.
Whatever meds you’re prescribed, you’ll start on a low dose, and be monitored by your GP to see whether you need a higher dose, and to check your side effects. Don’t expect relief immediately; usually these drugs don’t become fully effective for 2–4 weeks, which I know can feel interminable, but don’t stop taking them, or give up hope.
As with so much to do with mental illness, taking drugs for mental-health problems still comes with a huge stigma attached. This is in part because some who have not had cause to take them find it hard to understand why other people do. It’s also to do with ignorance, or a lack of education around what the meds actually do. Headlines in some sections of the media don’t help, to put it mildly. A NATION HOOKED ON HAPPY PILLS yelled the Daily Mail at the end of 2017[46] – the implication being that those of us who take antidepressants do so for an easy fix, or for a high that doesn’t actually exist.
So, for clarity: does taking antidepressants mean that you’re crazy? (No.) Do they mean you’re dangerous? (No.) Don’t they make you a robot unable to feel emotions? (Hahaha. NO.) But yet still we feel shame or hesitancy in telling those we love about them. A 2011 study showed that one in three women in the UK will take antidepressants in their