Anxious living
MEDICINE JOHN ROWAN WILSON
There are two classes of people I have always thought there was something odd about: body- conscious men and mother-fixated women. This is just an instinctive reaction and I have never claimed any clinical basis for it. However. I was interested to see it confirmed recently in an article by no less a person than the Professor of Psychiatry at Newcastle University. Evidently these two groups are now regarded by the psychiatrists as particularly prone to the de- velopment of anxiety neurosis.
As we all know, they are not alone in their vulnerability to this excessively common condi- tion. Anxiety is everywhere; it exists. not only on its own, but as an overlay to physical disease. Its prevalence is shown up in a quantitative way by our vast consumption of tranquillisers and sedatives.
A reasonable degree of anxiety, directed to- wards some specific danger, is, of course, not a symptom at all : it is a normal emotional reaction. Unhappily it is a reaction which very easily gets out of band. Anxiety neurosis is persistent anxiety without an obvious. dis- coverable cause. The patient is afraid, but he cannot give a logical explanation of what he is afraid of.
Anxiety may overlap with depression, but is distinguished from it by the fact that the depres- sive feels hopeless and resigned about his pre- dicament while the anxiety neurotic is tense, and often irritable and aggressive. Often the root of the condition lies in a competitive situa- tion, which taxes the individual beyond his or her ability to cope. With men, this usually occurs as a consequence of stresses at work.
Particularly in business, where objective stan- dards of competence are few and where chance plays a great part, executives are only too fre- quently promoted beyond their capabilities and the consequent anxiety shows itself in such manifestations as irritability, indecisiveness, and excessive drinking. Schoolboys who are plunged into the more taxing atmosphere of university life, wives who find themselves faced on mar- riage with larger social responsibilities, students from Africa and Asia translated into a Euro- pean environment which presents unfamiliar- problems to them. are all likely candidates for this kind of neurosis.
Effective treatment is not easy. For one thing, the conditions that have given rise to the trouble may be impos,ihle to change. It is not really practicable to tell the managing director of Consolidated Goo to resign his job and get back to something he can handle, like running a tobacco-shop. If a woman has six children and only sufficient energy to look after two,. you cannot advise her to hand over the others to Dr Barnardo's. Anxiety is one of those areas of medicine where you do what you can towards correcting the cause, but what you can do is often disappointingly little.
But if the situation cannot be changed, the doctor can at least help the patient to take up a more realistic and balanced attitude towards it. This process is known as psychotherapy. In psychotherapy. the first thing the doctor does is to listen. This isn't easy, particularly if the doctor is busy and the patient is boring, but it is essential. The very fact of describing his problems to a person who appears interested and sympathetic. yet has no personal involve- ment and no axe to grind, is therapeutic in it- self. When the doctor has gained the patient's confidence, he is able to contribute something positive by explaining the nature of the condi- tion, calming irrational fears, and making sug- gestions about the best way to reduce the strains which had led to them.
Easier said than done, I admit. The doctor has to beware of either being so passive that he gives insufficient support, or so positive that the patient becomes excessively dependent on him. If he gives no advice the patient feels the consultation has been a waste of time; if he gives advice which is impractical in terms either of the situation or the personality of the patient he can create a basis for further anxiety.
Drugs are not an alternative to understand- ing and sensible advice: however, they may be a considerable help. There is a vicious circle element to anxiety neurosis. When patients are very anxious. they may become so preoccupied with their own distress that the doctor cannot make satisfactory contact with them on a con- versational level. Severe neurosis may give rise to physical symptoms such as insomnia, head- ache, or dizziness, and these evoke anxiety in their own right. Tranquillisers and antidepres- sapt 'drugs have the effect of breaking the circle. They calm the patient down and make it pos- sible for him to discuss his predicament more sensibly.
But when all this is said. one has to admit th4t the treatment of anxiety neurosis is still a long way behind the treatment of most physical diseases. Perhaps one of these days we shall have the means to handle it more decisively. In the meantime, the subscribers to body-building magazines and young wives who feel an im- pulse to telephone Mummy several times a week would be well-advised to start watching themselves. They may be heading for trouble.
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