Do I really understand what my clients are going through?

on Thu 4 Dec

Kady Morrison December 4, 2014

"About five years ago, I was diagnosed with an anxiety disorder. This did not come as much of a surprise to me, since for the previous two decades, I had spent my time freaking out about any number of things. Some of my fears were rational, and some were less so, but all of them had one thing in common: they had a level of control over me and my day-to-day life that fell outside the range of normalcy.

Since then, I've expended a lot of energy working out the best ways to manage my anxiety. As with most endeavors, there have been some successes, some failures, the occasional moment of unintentional hilarity, and — by the very nature of the beast — a few panic attacks. I like to think that these days, I pretty much know the ropes. But if there's one thing I could change, it's not the anxiety itself, nor even the ease and availability of treatment. It's how often I find myself in tense, uncomfortable, or painful situations with people who just want to help; it's how often I find myself thinking, "Man, this whole thing would be so much easier if you just understood a little more about anxiety."

So, without further ado, here are the top nine things I wish I could magically make the whole world understand about anxiety and those who live with it.

1) Anxiety does not move in a straight line

For folks who move through life without an anxiety disorder, I imagine fear and panic as emotions that are pretty straight-forward: something happens, or is projected as going to happen, that causes an apprehensive or frightened response. But for a person with an anxiety disorder, things don't work that way. Perhaps this is best illustrated by example. Let's think of something minor — like, say, losing your car keys. That would of course be frustrating for anyone. A person without anxiety might think something along the lines of, "Oh no, what a hassle!," or maybe even, "Oh no, this is going to screw things up for me for a few days!" But for someone with anxiety? Well, that train of thought might look more like this: "Oh no, my car keys are gone! What if I don't find them? What if I try to get them replaced but it's not possible or it takes forever and something happens and I need my car and I can't get in it? What if the thing that happens is that I need to drive someone to the hospital? What if that person is my best friend? What if they're dying and the only way to get them to a hospital is my car and my keys are still gone? Oh, god, I LOST MY CAR KEYS AND NOW MY BEST FRIEND IS GOING TO DIE AND IT'S ALL MY FAULT."

This brings me fairly neatly to my second point:

2) Anxiety is not rational, and boy, do we know it

Like, seriously, I promise you: we know. You really cannot spend all day every day listening to the thoughts of an anxious person and not know that a large portion of those thoughts make approximately no sense at all. Just last week, I found myself worrying that my parents would look at the person I was and decide they hated me, despite knowing to the depths of my soul that is not something that would ever occur. This is one of the most frustrating things about having an anxiety disorder: knowing as you're freaking out that there's no reason to be freaked out, but lacking the ability to shut the emotion down. A therapist of mine once compared it to having a faulty alarm system wired into your brain — rather than going off only when something is really dangerous or scary, the anxious person's mental landscape will fall to chaos over all manner of things, however tiny or inconsequential. In fact, sometimes the thing that causes the reaction is so tiny or inconsequential that even we don't know what it was. Other times, something that has caused a reaction in the past is a total non-event in the present.

3) With anxiety, some days are good days, and some days are bad days

I mean, don't get me wrong — this is true of life in general. But I mention it because it's the thing I most often find myself wishing everyone in my life already knew: some days are good anxiety days, and some days are bad anxiety days, and whether I'm having a good anxiety day or a bad anxiety day is going to affect the way I react to the things and people around me. If, for example, I'm having a bad anxiety day, and somebody in my life gets angry at me? There's a pretty decent chance that I'm going to either a) have a panic attack, b) burst into tears, c) say anything I can think of to make their anger go away, or d) all of the above. Of course, I can't (and don't) expect the people in my life not to get angry at me, or to only get angry at me on specific day; sometimes I do things wrong, and make people angry, and that's normal, and healthy, and okay. But I wish it was also considered normal, and healthy, and okay for me to say, "Hey, I'm having a bad anxiety day, can we do this another time," and trust that the person I'm saying it to knows it's not a cop-out or an excuse so much as a delay — and a request for kindness.

4) Anxiety is physically painful

Of course it's emotionally painful, too — in fact, I'd argue that the emotional pain is the worst of it — but most people know that part, and not this one. So: surprise! Anxiety hurts. Panic attacks are the pinnacle of the physical pain piece for most of us, since so much of that experience is centered around the sensation that your chest is tightening to the point that you can't breathe. But anxiety can also cause headaches, nausea, heart palpitations, muscle tension, insomnia, dizziness, and exhaustion. There are people who have deeply painful gastrointestinal responses to anxiety (ever heard the phrase "tying your stomach up in knots?"); there are people who, when anxious, hold their muscles so rigidly that they end up pulling or tearing them. It hurts. It doesn't hurt the same way for everyone, but it hurts. And that brings me to:

5) Not all anxiety is created equal

I, personally, have generalized anxiety disorder — or, as I like to think of it when we're at home, "everything everywhere all the time always disorder." But anxiety comes in many different varieties and flavors, and so do people's experiences of it. Some people suffer from generalized anxiety; some people deal with social anxiety; some people have specific phobias. Some people come by anxiety genetically; some people develop anxiety as the result of a specific event; some people have anxiety due to their brain chemistry. Some people have been anxious all their lives; some people develop anxiety as a teen or adult; some people eventually overcome anxiety, or at least figure out how to manage it to the point that it's negligible. Some people medicate their anxiety, and some people don't. Some people see a therapist to help them with their anxiety and some people don't.

6) Anxiety and depression are linked

Not all anxious people have depression; not all depressed people have anxiety. But they are known within the mental health community as common companions — and, in fact, one can lead to the other. If, for example, some hypothetical person with an anxiety disorder had the tendency to freeze up when overwhelmed, and had difficulty reaching out to the people in their life when that happened, then that hypothetical person could, hypothetically, remain frozen for long enough that eventually the anxiety (and all their other feelings) could bleed away and leave just the stagnation — in other words, depression. You know, hypothetically. That could occur.

The reason this is on this list isn't because I think people don't know about it. I actually think it's fairly common knowledge, or at least it is in the communities I travel in. It's because I want you, reader, to understand that we know. We the anxious are typically super aware of the fact that there's a link between anxiety and depression, and — shockingly — it's safe to assume we're pretty anxious about it. For those of us who have experienced a depressive episode in the past, it's even more likely that we're quietly freaking out on a pretty regular basis about the chance of that happening again (which, actually, is a rational fear, as your likelihood of experiencing a depressive episode increases with every time you have one). Probably don't bring it up out of the blue, is what I'm saying here. That, and keep an eye out for it if you can; as freaked out as an anxious person might be about getting depressed, it's really difficult to notice a depressive episode once you're actually inside of it.

7) Unless you've been given explicit permission, when it comes to someone else's anxiety, you should probably listen instead of talk

You know how it's okay when you say something nasty about a member of your family, but if someone else does it, you're going to come down on them like a ton of bricks? This is like that. I can talk about how exhausting or infuriating I find my anxiety, but if you do that, it's probably going to hurt my feelings; I can say that I wish I didn't have anxiety, but if you say that, I'm probably going to think you're an asshole.

Also — and man, do I wish this went without saying — it's never okay to talk to about someone else's mental health issues with a third party, unless you've been given explicit permission to do so, or if your relationship with that third party is one involving legally enforceable confidentiality (your therapist, your lawyer, et cetera). Just because someone has told you something about themselves does not mean they're comfortable with everyone else knowing it. I, obviously, am comfortable with everyone on earth knowing that I'm a nervous wreck, because I would not be writing articles on the internet about it I wasn't. But mental health issues, anxiety included, are still heavily stigmatized in any number of communities, and there are a lot of people who aren't at all okay with people finding out about their struggles. There are even people for whom that's an active anxiety trigger. So, you know. Don't do the thing.

8) As frustrating, infuriating, agonizing, and exhausting as it can be, our experiences and struggles with anxiety are part of us, and we wouldn't be the people we are without them

This is actually something I think people with anxiety, myself included, really struggle to understand. We spend so much time trying to work through our anxiety that it can become almost like another consciousness living within our brain: an enemy that we need to get rid of in order to live full, productive lives. The reality of the situation, as usual, is more complicated than that. Though our anxiety is something that we have to manage, it's also part of who we are. It shapes choices we make, the way we looked at the world, and even facets of our personalities. To look as it as an enemy is to deny that part of ourselves any validity.

About a year ago, my therapist pointed out that I am an anxious person, that I am probably going to be an anxious person for the rest of my life, and that my personality involves certain quirks and tics that are the result of anxiety. It shocked me, even though I'd known for years that I had generalized anxiety disorder — I thought of my anxiety as a disease that needed curing instead of as an (admittedly frustrating) part of who I was. Since then, I've worked hard to stop thinking that way, and it's hugely helped me to dispel the lingering sense of failure and inadequacy that I'd known for years as anxiety's partner in crime. It's okay to be an anxious person, and that's something worth mentioning to the anxious people in your life — they really, honestly, might not know that.

9) And, finally, the most important thing I wish everyone knew about anxiety, and about mental health issues in general: if you know someone with anxiety and you want to help them, ask them what would be helpful, ideally during a time when they are calm and non-panicked

The most unkind thing you can do to a person with anxiety is to pile on, which can be a tricky thing, because it may be something you do without realizing it. The thing about anxiety is that it makes possibility-spinners of all of us — we are, as a group, the sort of people who look at what could happen instead of what is happening, whether we want to or not. And this results in hyper-aware, hypersensitive people more often than it doesn't; it's impossible to torture yourself with thoughts of how others might behave or react to things if you don't know how others generally behave or react to things. Your frustration with us and our spiraling thoughts, your exhaustion at how difficult we can be to deal with, your annoyance at our anxiety-rooted behaviors, your wish that we could just cut it out: we know you are feeling those things. We can tell. And, perhaps more to the point, we are feeling them also — we are also frustrated, exhausted, annoyed at ourselves. We also wish we could just stop. The difference between us and you is that we are thinking those things all the time, because we spend our lives with that anxious personality that can become so grating. There is also a great deal of guilt and self-loathing that comes along with those thoughts for us, both because most of us are struggling daily to feel better and because we really don't want to bother anyone.

It is okay, if you have an anxious person in your life, to find them frustrating or exhausting or annoying. Nobody is blaming you. In fact, believe me: we get it. But you have the ability to walk away when you find yourself responding to someone's anxiety that way, and that gift (and it isa gift) is not one we share. It is better to walk away from an anxious person than it is to feed their frustration with your own. It is better to walk away from an anxious person than it is to tell them they need to calm down — we know we need to calm down, and hearing you say it only adds guilt and failure to the pile of emotions that was already overwhelming us. Distracting us can be helpful, listening to us can be helpful, even sitting with us in silence can be helpful, but please, I beg of you, don't pile on. It makes it so much harder to get to a calmer place, and we really want to do that.

As for what you should do, much though I appreciate your making it to the end of this article, there is no advice that I, A Stranger On The Internet, can give you that will be better than the advice that they, The Person You Actually Know Whose Specific Experience You Are Concerned With, are going to be able to offer. They know themselves, and that makes them a lot more likely to know what they need than I am. You'd be surprised by how many people are afraid to even ask the question. Do not worry, friends. The anxious person in your life? They know they are anxious. Your bringing it up is unlikely to startle them.

In the event that you do ask them and they don't know what they need, then I will say this: everybody needs kindness, especially people who are predisposed to being unkind to themselves. You'd be amazed how much little things — a smile, a reassurance, a compliment, a sandwich — can lift somebody's spirits, and people with anxiety are often afraid or unable to ask for those things, even when (especially when) they need them. So that's my advice: kindness. It's a hard one to go wrong on."


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