Anxiety: The Canary in the Coal Mine (Part I) 

You don’t have to look far to see statistics about the rise in referrals to mental health services. Google whatever you want – it's all bad news! It’s tempting to blame it on the pandemic, but the rise began well before that. It’s tempting to blame it on politicians under-funding the NHS, but the increases seen won’t be fixed by a few percent on its budget. Instead, we need to stand back, think differently and analyse our anxiety-generating culture.

As a psychiatrist, one of my roles is to say when something ISN’T mental illness. In my clinic last month, I met with a man who was seeing visions of his deceased wife – and I was able to say that this was complex grief and not psychosis. I also met a man crippled with obsessive compulsive disorder who has been hugely helped by antidepressants and cognitive behavioural therapy. However, when I look at what is called ‘anxiety’ in our culture, I don’t see an illness I can help with. It's not one I recognise or know how to treat – or at least not yet! 
 

Anxiety – but not as I know it…

I do, of course, believe in anxiety disorders and clinical depression – I treat them every working day. And please don’t misunderstand me – if you think you have significant mental health problems that are affecting the way you function (such as at work or in your daily relationships), then please speak to your GP. 

However, what I am talking about here is more of a diffuse “angst” or “ambient anxiety” that is everywhere you turn – worry about the state of the wider world, fear that social media is destroying our brains, apathy about my part to change things, a vague paranoia that something must be behind it all. At its heart is stress that seems to arise from the very fabric of everyday life, even in the absence of particular stressors. In 2018, the Mental Health Foundation found that 74% of people have felt “so stressed they have been overwhelmed or unable to cope “[1]. 

These things can turn into anxiety and depression if they go on for long enough, as people withdraw from positive behaviours and community, and turn to less helpful coping mechanisms like alcohol and avoidance. Hence the ‘not yet’ in the second paragraph above. But this anxious “angst” in and of itself is NOT mental illness. It’s therefore distressing to see so many today looking to medical diagnosis and psychological solutions. 

You may wonder why I am so concerned about this, and there are two reasons – one statistical and one more pragmatic. Statistically, the medical profession has only ever diagnosed the more severe end of the spectrum. If we take height as an example, we know there are conditions that result in reduced stature and for some of these there are treatments like growth hormone. However, to say that 50% of the population are below average height and need treatment would be ridiculous. It’s mathematically accurate, for that is what an average means. But to set this as the benchmark for intervention is ridiculous. It’s surely even more ridiculous to go further and aspire for a ‘perfect’ six foot tall – but if you pop into a shop and browse the fashion magazines that is what seems to be in demand...

Mental health conditions do not respond to objective analysis such as a lab test or X-ray, so there will always be a degree of debate about where the cut off between illness and wellness lies. This is one of the reasons why seeking advice from a mental health professional is important if you think you might be ill. However, even the most inclusive diagnostic systems keep the prevalence well below 50%. 

So, to say that "most” of our population are anxious cannot be said at the same time as saying they have a mental health condition. They may be anxious and they may feel there is something wrong, but let’s not take the next step of medicalising this and referring for an individualistic treatment when it is not the individual who has a problem. We used to say 1-in-4 of us would have a mental health condition at some stage in our lives. If that is now 1-in-2 or even 74% at any given time, then let’s think again rather than refer more. A friend told me of her daughter’s class at school where literally every child except their own had a mental health diagnosis of some kind – this is not medically possible!

The other reason is more pragmatic – I'm on the receiving end of these referrals and I don’t know how to help! The main treatments for anxiety and depression will not help and may even make things worse. When we are ‘just stressed’ but still functioning and with a relative absence of the ‘biological’ symptoms of depression, medication can result in side-effects with little benefit. Cognitive Behavioural Therapy assumes unhelpful cycles of thinking and behaviour that cannot be changed if every day thinking and behaviour is still present.

Both medication and psychology – and this is the really important bit – internalise the issue inside our own brains. They say that OUR brain is the thing that is broken and so WE need to sort ourselves out.  This is true if our brains are ill, but not if they are not! Whilst our society claims to be more open and accepting of mental health conditions, this medicalisation contains implicit stigma. We feel we need to get with the programme and, when we can’t, the voice in our head says ‘keep up or keep quiet’.
 

Anxiety as feedback

Australian pastor and thinker, Mark Sayers, says that this sort of anxiety is more a symptom of society than the individual. He says that “Anxiety is feedback for a failing culture.” [2] In other words, if everyone is getting more anxious then we need to look deeper to find out why – and he suggests we look at our culture which is promising peace and happiness but not delivering and is serving up cultural anxiety instead.

The first place to look at is what people are anxious about. Sure, they are worried about their mortgage, their job, or their health. But deeper than this is a more primal and existential angst – they are anxious about who they are, why they aren’t living the dream and what to do when the recommended fixes don’t work. The imperative to seek an NHS referral comes in part from the emotions people are experiencing but in part from a feeling that the world is moving on and they are being left behind. 

This is a good time to say again that I am NOT advocating not seeing a health professional if you are worried about your mental health. They are well placed to assess this, offer and advice and (if needed) treatments and referral. The last thing I want to encourage is silence and avoidance when it comes to emotions. Medication and therapy have helped and continue to help millions. What I am saying is that, when these approaches don’t work and when the numbers rise to ‘pandemic’ levels [affecting pretty much everyone], and if the health professional says this isn’t something they can help with – then we ALSO need to stand back and take a wider view. 

Another place to look is our own history. I recently watched the BBC mini-series, starring David Tennant, of Jules Verne’s “80 Days Around The World”. Travel around the globe was opening up thanks to ‘modern’ machines and it seemed as though anything was possible. Verne continues this theme with “20,000 Leagues Under The Sea'' where a submarine ‘powered by the great electric fluid’ deals with any challenge. Given enough time, surely man will reach the stars! However, you don’t have to dig too deep to see the issues: it’s a world largely run by men (albeit with luxurious moustaches), other nations and races are just pawns in these Empire games, and when the money runs out it all grinds to a halt. 

Over the past few decades, we have been sold a system, a world view, a destination. It’s not a modernist empire with Victoria on the throne, but it is a similarly conceived Nirvana. Given enough time, humanity will... [dot dot dot] - what would you insert here? The list might look something like this: that science will overcome superstition, that medicine will cure cancer, that we all just need to be nice to each other and more tolerant, that this or that political left/right/centre/wing has the answer, that being true to yourself holds the key, that swimming in icy water will heal your brain. They are all attractive – except perhaps that last one!
 

But the reality is that, for most of us, we have been sold a lie! 

For a small number of what Sayers would call ‘elites’, things seem to be going well. These are the ones on the front covers of the fashion magazines. Let’s run through that list again - they embrace technology but also spirituality, their latest diet wards off cancer and everything else, they invite guests to stay and work for world peace, they keep politics quiet but secretly give, they hold true to their personal values and celebrate diversity, they have had a personal retreat with Wim Hof. 

But for most of us, the system isn’t working, the world view doesn’t offer much of a view and the destination is becoming a sick joke. Technology isn’t answering the ‘why’ questions, our weight yo-yos, we read the news (we are not being nice to each other), politicians seem as bad as the news and trying to be the ‘best version of me’ is simply exhausting. Each year, I usually end up going for a swim in the Scottish sea – it's invigorating (I tell myself), but the feeling doesn’t last. Turn to page seven of the fashion magazine to see the failing elites. 

The result of all this “I want that life but each time I try I fall flat on my face” is what we feel as angst, comparison, a feeling it is tantalisingly out of each. That word comes from Greek mythology, from a son of Zeus called Tantalus. He was made to stand in a pool of water beneath a fruit tree with low branches, with the fruit ever eluding his grasp, and the water always receding before he could take a drink. To tantalise means to torment with the sight of something desired but out of reach; tease by arousing expectations that are repeatedly disappointed.

We also call it anxiety… or depression... or, like the 74%, the stress of everyday life where we feel overwhelmed and unable to cope. 

Anxiety is feedback for a failing culture. In the rest of this article, I want to call out what we are sold as truth but actually has no more substance than the Emperor’s new clothes and we are suitably as anxious as we were naked the day we were born. But the answer isn’t pills or therapy – it's, well, clothes. 
 

Anxiety is also the canary in the coal mine. The canary. The bird that the miners of old used to take deep into the mines to warn them of the release of coal gas – a heavy blend of carbon monoxide and methane that would drown out the oxygen. When the bird stopped singing, it was time to stop work and head for higher ground – before a spark triggered the flammable mix. In today’s so-called-advanced culture, I’m struggling to hear any song…

Why did we fall for it?

Humans believe in fairly predictable things. We know that every Disney movie offers us a kind of salvation – and we love it! We all love a hero who has undergone his hero’s journey and returned from his dark place to save us – and we want to follow. Even in stories that focus more on character than plot, we all prefer the good guys to win in the end… 
Traditionally, humans have followed a faith-based world view that explains this. I’ve laid out the Christian steps below but these are found to some degree in all major faiths. It starts well, turns sour and [this is the important bit in Christianity] God draws us back. 

Eden – a place of perfection [that we have sadly left]

Fall – the manner in which we left it [the effect of our own and others’ choices]

Sin – the resulting state [which drives us back towards God]

Salvation – the path back [offered by God and not us]

Discipleship – the further outworking of this life [led by God]

Heaven – the destination [to be with God], Eden again but more secure

For good reasons, the Enlightenment and Post-modern thinkers have brought other valid perspectives over the past 200 years. One specific example is that science has helpfully pushed out the ‘god-of-the-gaps’ as we no longer feel the need to placate the volcano god to stop our crops failing, and instead we can marvel and wonder at the beauty of the world around and the systems therein. 

But it has also challenged the idea that God draws us back, that we need a God at all, and it has put mankind firmly in control of his own destiny. And so a new culture arose which we made ourselves, find our own salvation and engineer our own revivals. It goes something like this:

Inner Child – Once we were young and free… If only it could stay like this!

Trauma and Captivity – Stuff happened, Expectations were put upon us

Isolation and then Anxiety – Am I the only one who feels this? Help!

Flight into Pleasure – I need more stuff, more achievements, more zen

Shape your Outer Self – Fake it to make it, Be the best version of you

The result IS pleasure – If it is not, then repeat steps 4-6. 

The cruel thing about this salvation (gospel/revival) is that it is all on you. The word gospel is not a Christian one – in Roman times it just meant some ‘good news’ or even just ’news’. It’s a plan to follow, a factory production line that is designed to deliver pleasure. So, on this production line, we are told that the result IS pleasure because surely that was what was promised. And if that is not what you reap then there must be something wrong with you... 

Repeat steps 4 to 6. Try harder, push deeper into yourself. And again. And again. On page seven of those fashion magazines, we see those who fail publicly – with alcoholism, a messy divorce or botched botox. Yet on the pages of our own hearts, we read the signs as well of isolation and anxiety as we feel awful and cannot talk about it. 

In 1987, the Beatles said, “All You Need Is Love”. Sadly, the evidence suggests that they were wrong. The production line seems to be designed to produce pain and not pleasure...

The tricky thing is that it’s not all bad news today. Hans Rosling's amazing book “Factfulness” shows from hard data that across the globe poverty is decreasing, education is increasing, health is improving and population growth is slowing [3]. However, this is largely because the old divides between east and west, developed and developing, are being broken down. 90% of the world’s children are now immunised against conditions that kill.

What Factfulness doesn’t talk about is what kind of society we are saving them into and what is happening with the parts of the earth that house the privileged elite. Life expectancy in the UK and USA has fallen over the last five years. 40-50% of marriages end in divorce – the figure is higher for other types of ‘long term’ partnership. With the ascendency of China and a global marketplace where billions compete, the once-superior ‘West’ needs to wake up and smell the coffee!

So, what are we going to do about this? Read Part II in this ‘Long Read’ (coming 21 May).

____

References:

[1] https://www.mentalhealth.org.uk/explore-mental-health/mental-health-statistics/stress-statistics 

[2] https://www.premierchristianity.com/finding-peace-in-the-age-of-anxiety/13368.article

[3] Factfullness, by Hans Rosling – buy on Amazon https://amzn.to/3nlI5IO