En Route

It's a while since I posted on here as I only do so if I think what I have to say is useful. Well, this morning during a period of reflection my mind went back to my teenage years. I've referred before to my experiences of mountain walking and this is another memory.

There was a group of us who used to go on a night hike once a year. Always the same walk; always the same time of year. Each June we used to hitchhike from Salford to Shap Village in the Lake District. Once everyone had arrived we would set out with only moonlight to show the way and follow a track past a farm and onto the fells. The sun would come up around four in the morning by which time we would be in the middle of nowhere, open moorland in all directions. Soon we would arrive at a beck with a footbridge. We stopped there for an early breakfast, then it was on again, climbing now before descending into the next valley, the next and a third. By now people were starting to get out of bed and get ready for the day; but not around us. We were still in the emptiness.

We knew where we were headed, of course. We knew we were making good progress. But also by now we were feeling the effort, tiring, but we still couldn't see our destination. It was hidden behind the twists and turns of the track, by more ridges ahead of us. We knew it was there but really, how much longer?

It struck me this morning that this analogy fits many of life's situations. Not least it describes the journey through mental ill health. As one of the Old Testament prophets put it, "How long, oh Lord? How long?" I don't know how long the journey will be for you. But I do know, from those night hikes, that you are on the right path and you will get there.

On Not Knowing What Will Happen

This is not a blog in the usual sense of being a sort of journal that simply unrolls across time. It is more by nature of an online handbook which has tips, hints, advice and how to’s about a very common problem, clinical anxiety. When I have said everything I feel that I can, it will stop. In the meantime, in the absence of specific questions long periods may occur between one post and the next. As has happened here. I don’t write it for the sake of writing it, but only post when something occurs to me which may be helpful. As is about to happen here. A very common source of anxiety is concern about what the future may hold. It’s an anxiety that may be vaguely concerning or it may be so severe that it overwhelms and paralyses the person. It is usually brought about by some major change in our lives which appropriately raises the question, “What happens now?”, and to which the answer is, “I don’t know.” But we want to know. Indeed we tell ourselves that we need to know, and the realisation that we don’t know fills us with fear and foreboding. Understandable but misguided. The truth is that there is nothing in the slightest way unusual about not knowing what the future holds. It’s just that normally we don’t notice. We have sufficient experience of past patterns to make predictions about future patterns, which generally speaking come to pass. I have a medical appointment tomorrow so I shall present myself at the health centre in good time and undergo the test that is scheduled. That’s my supposition. It’s well-founded because that’s what I do when I have medical appointments. But until it actually happens, it’s only a prediction; it’s not a reality until it happens. To give you an example. We are planning on moving back to England. Recently we were there for three weeks on holiday and decided that we would spend a few days on the Isle of Wight, the area we want to move to. I booked three nights in a B & B, we packed a case on the Sunday and had our rail tickets for Monday morning. But on Sunday night my wife was hit by severe stomach cramps which prevented her from sleeping much, and they were still with her on Monday morning. So we cancelled. We didn’t got to the Isle of Wight after all. It wasn’t a disaster, but it was a disappointment. The stomach cramps cleared up quickly and my wife returned to normal health. We ‘knew’ what we were going to do, but we didn’t do it; circumstances changed. So the first lesson to take hold of is that circumstances change all the time, but mainly we don’t react with fear or anxiety. Fear and anxiety are reserved for the big changes that come unforeseen - a spouse or partner dying or leaving us, a redundancy, an unwanted pregnancy, diagnosis with a serious illness. Things which basically we hadn’t planned upon happening. There is a second, equally important lesson to be learned; we will survive, Things will be fine. Different but fine; we will survive. It’s a strange characteristic of human beings that we always think that we are the finished product; that we are how we will always be and that life is settled and will stay like this. The only trouble is that we are wrong. Think back to the person you were at the age of twenty - what you were doing, your interests, job, where you were living, who your friends were. Now leap forward ten years to the age of thirty and look back from there. Can you believe that so many of those things could have changed so much in just ten years? Now come to the present day and see how much has changed since you were thirty. Most of the changes that occurred were things you would not, could not have predicted, and yet here you are today, different but still in one piece. Why then would you expect the future you to be the same as you today? It hasn’t happened in your past. Why should it happen in your future? Know this then; you don’t know what the future holds but it’s odds-on that it and you will be fine once you’ve made the transition from what is to what’s next. In the words of the cliché, life is a sentence; living is a process.

Weasel Words

Language is a wonderful gift. It allows us to communicate enormously complex information from one person to another. It provides us with song, poetry, literature as well as a vast range of technical information. It allows us to share experiences to the mutual benefit of all. Sadly, it also has a downside. I want to look at one aspect of that downside, as it affects people who are struggling to come to terms with some difficulty or another. Inside my head lights flash and alarm bells start to ring whenever I hear someone say to me, "If I were you.....". Unlike me, they don't have the full facts about my current situation, the one that they are about to help me with. They only have the picture as their imagination paints it for them and so what they say next will reflect that. It will be overly simple; it will almost certainly be something that I have already considered and rejected on at least one occasion. But most of all, they are lying - unconsciously admittedly, but still lying - because they are not going to tell me what they would do if they were me; they are about to tell me what I would do if I were them, which is very different. I am not them so no matter how good their solution is, it probably won't be appropriate for me. Their solution will lack an essential component, insight. So, for example, if I say that I am too frightened to fly to Australia, they might say "Why don't you just fly from Manchester to London as a start." Be suspicious of people who want to give you advice and solutions on a plate. No matter how authoritative their position, you should trust your own instincts (Yes, I know that's advice; I apologise; ignore me.) Actually that's a useful guide to a successful therapist, counsellor or life coach; they focus on listening not on telling. They use questions more than statements. In that example for instance, a good therapist will ask something along the lines of "What is it that you fear?", following up with more questions in an effort to understand the root of the problem. Next I would want to pursue another line of enquiry;"Have you thought about what you might do to tackle your fear?", "Why did that not seem a good idea?" Two weasel words of advice to really run away from are 'should' and 'ought'. Each describes a course of action - mental, emotional or physical - that the person offering presents wrapped up in an obligation to do something you're not doing, very likely for a reason. I enjoy painting in watercolour, not that well but I have sold a couple of pictures over the years. It was something I thought I couldn't do, but eventually tried and was pleased with my first attempt. I showed it to an artist friend who agreed that I had some ability. "I think I should sign up for some classes", I said. His advice was a categorical "No!". "A teacher will show you how to paint like he or she does. Paint the way you do. If you keep at it, you'll get there on your own." He was right. Ten years after that first painting I returned to the exact same subject and painted a new version. There was no comparison between the stumbling of the original and the competence of the second. Take all the help you can from people who see their role as being to assist you in finding your own way out of your present difficulties, and trust your instincts. And keep a keen look-out for those weasel words and phrases.

Don't Look Back?

I hear it said a lot to people who suffer with depression, that you shouldn't dwell on the past, but look to the future. Whilst I may agree with the first part of that advice, it shouldn't be seen as a total ban. As for the second part of the sentence, about the worst thing you can advise someone feeling that going on is too overwhelming, is that they should focus on that future they fear. But this blog is mainly about anxiety, not depression. I say mainlybecause what I want to write today actually applies to people undertaking any kind of therapy, but which is often overlooked or ignored. You want to get better. You are trying as hard as you can to keep moving forward towards some kind of 'normal' life, but at times it looks as if there is so far to go that you will never get there. How do you give yourself the courage and the incentive to keep at it? In my youth I used to spend a great deal of time walking in the Lake District; we called it hiking in those days; I don't know if that's still the case. The Lake District isn't just full of lakes. It is also a mountain region. so walking in the Lake District usually involves climbing up one side of a mountain in order to climb down the other side - and then do it all over again to the next mountain. Even if you are fit climbing a mountain is hard work. With every step you lift your whole body weight, plus whatever pack you are carrying, a few inches higher up the slope. Say your step is ten inches and the summit of the mountain is 1500 feet higher than the point where you sart, then you are going to have to lift your body weight another ten inches up the mountain 1800 times before you get to the top. Hard work. The way we dealt with this was to take a rest from time time to time to get our breath back. Not for two long though, or it took that much more determination to set off again. So short pauses punctuated the ascent and made it more easily achievable. But what was also important was what we did duringthose pauses. We turned round and we looked back in the direction we had come. And that was when we could see just how far we had already come - the tiny farmhouse at the foot of the fell: the ant-like people down by the side of the lake. That was a tremendous encouragement, and so off we went again with renewed vigour. It's just the same when you're struggling to make headway in therapy, every step so laborious and demanding. Stop. Pause. Have a rest and get your mental breath back. And take a good long look back at how far you"ve come. See how your progress is much greater than you had imagined or given yourself credit for - and give yourself that credit now. While I'm on this theme, just a word or two about the climb that still awaits you. I would look up and I could see the summit and the sky above and beyond it, and on I would go thinking "Not far now". Then I'd get near the summit only to see that it wasn't the summit at all. Simply, the gradient had changed so that although the next stretch was easier because it was less steep, before too long the mountain reared up again and mockingly looked down at me. The worst of these times was when you actually had to go steeply down into gully and then slog up the other side just to get back to the height you were at now. It's the same in therapy. So often it feels as if you are nearly there and then you get a different perspective and realise that the journey is longer than you think; and sometimes you have to lose height to stay on track and then climb it all over again. That's another reason why pause to get your breath and look back are important.

Delaying Tactics And Why They Help.

Anxiety comes upon you in different ways depending on what type it is. Separation anxiety never really quite goes away; it's somehow always there in the background. Existential anxiety suddenly deals you a hammer blow. Situational anxiety, on the other hand, sneaks up on you. It begins so small you may not even notice it. Then it grows. I'm reminded of something I once heard about cooking a live frog, assuming you would ever want to do such a thing. If you simply take a pan of boiling water and drop the frog in, the frog's reflexes will kick in and propel it straight back out again. No, what you have to do is put the frog in a pan of cold water and then slowly heat the water up. The frog doesn't notice the heat at first, later it may but it also starts to feel drowsy before passing out and you can now cook it just how you like it.

Take a less gruesome situation. When you get a puppy you need to teach it obedience. The earlier you start, the easier your life will be later. Even though it may be hard work to get the message across, it's nowhere near as difficult as if you start with an adult dog. Anxiety that starts small is much easier to overcome while it is still small. And if you keep it small, it stays easy to overcome. With some made up figures, here's what I mean:

If you make a dentist's appointment this Monday for next Monday, and you really don't like dental treatment then the blue line shows what happens to your anxiety level in the meantime. Anything over 80% and you'll probably cancel. If, on the other hand, you acknowledged from the outset that you were likely to become increasingly anxious over the week you would be able to decide to devote time to reducing the anxiety every time it gave a little flutter. You can usefully use two strategies side by side.

1. Visualising yourself arriving at the dentist's feeling calm and remaining calm, using the techniques I've described, practising feeling calm, in other words, and taking that practice into the waiting room and then on into the surgery when you actually go.

2. Not ignoring the part of your mind that says "I'm bound to worry. I hate the dentist's" and not arguing with it, because you'll lose. Instead, agree but put off the start of worrying; "Of course we'll worry about it but not today. It's a whole week away". And later, "Yes, I promise we'll worry, but let's leave it until the weekend. That's plenty soon enough." With a bit of luck there'll be something to distract you from worrying across the weekend, and then you've only got a bit of Monday to deal with. The green line illustrates how that can pan out.

One final thing here. Notice that nowhere is it actually suggested that you should relish the visit; simply that unpleasant as you may find it, you can do it.

It's For Your Own Protection

Right at the beginning of this blog I referred to anxiety as the bastard offspring of fear and imagination.I also  talked of fear giving us the means to deal with an actual, present danger, and thus the means to protect ourselves from harm. Anxiety performs the same function with regard to possible, imagined future threats, threats which don't exist but which anxiety treats as if they do.

I've also mentioned Freud's belief that emotions too powerful to express get buried in the subconscious part of the mind where they fester, perhaps for very many years. Freud also said something else which I have found helpful. He said that at a deep level people resist being cured of their neurosis, because, bad as it may be, what it is protecting them from is even worse (as they see it).

How does this relate to existential anxiety? Very simply, your mind will offer you all kinds of good reasons why you should shrink from tackling the problem *now*.

This is not the right time. Your protective mechanism will always tell you this; there is no absolute right time.

I can deal with it myself, slowly. Sorry, if that were true you would have dealt with it long ago - or even at the time these things happened.

I don't want people to think I'm making it all up or exaggerating. Mental health professionals won't think this at all. They have long experience of people imprisoned by distress like yours (though the causes may be different).

It would be better to walk away now so that someone more worthy may have the benefit of their expertise. No it wouldn't. You have been assessed by people who know what they are doing and have judged that you need and deserve the benefit of their intervention.

I don't want to have them lose patience with me and discharge me before I'm ready. They won't. They are in this for the long haul and they know it will be a lengthy and difficult process for you. They are prepared for it to take as long as it takes.

It's going to hurt too much. I would do better just to learn to live with it. Well at least there's some truth in that; it will hurt and that's why your mind shies away from dealing with it. But, it will not be more than you can endure, and you will be worse trying to live with it, not better. You survived the process that damaged you so badly; you will survive the painful process of healing.

An infected appendix requires surgery which leaves a painful incision wound. Rejecting surgery leads on to a ruptured appendix which results in peritonitis, shortly followed by death.

Have I missed any of your 'reasons' off my list? Tell me what they are and I'll explain why they too are excuses. 😄

Varieties Of Anxiety

The different types of anxiety that I wrote about also differ in the way that they manifest themselves. Separation anxiety is the consequence of deep distress at being separated from someone, which makes sense. This is why obstetric and paediatric practice these days is to ensure that mum and dad have the maximum possible access to their child when a hospital admission is necessary, so that feelings of abandonment are avoided as far as possible, and there is little or no long term effect in most cases. But separation anxiety is also common in everbody's life; it is a major component of that complex web of emotions which we call grief. A much loved partner, parent, grandparent, child or important other is snatched away by death and there is no hope (in this life) of reuniting. It may also come about as the result of a miscarriage or a marriage or relationship breakdown. The main way in which it is likely to manifest as a continuing problem in adolescent or adult life is in inappropriate behaviour to avoid a repetition of the experience. I'm thinking particularly here of people who have a pattern of breaking off relationships or friendships which to an outside observer seem to be developing well. They are, and therein lies the threat. So, get your retaliation in first; that way the pain is less. I am the eldest of three brothers. Six years ago, not yet sixty, my youngest brother fell ill and very shortly died. It came out of the blue. My other brother, once the funeral was over and we were all setting off for our various homes suddenly looked at me and only half-jokingly said " Right. i'm going to die next. I couldn't go through that again." I suppose I should be touched that my death would hit him that hard. Instead I thought, "typical of the selfish bastard!"

Existential anxiety is different. It hits you out of nowhere coming at you like a Formula 1 car going flat out. Why? Because in your past, probably in your early years something or things happened to you, or more likely, were done to you that were way too big to let go of, but way too big to handle. So your mind - the part Freud labeled the subconscious - stepped in to protect you. It buried them where you couldn't feel them, or only vaguely and tolerably, and you were able to survive. But at a price. That pain, anger, shame, guilt, despair festered and fermented, if you like, a build-up of emotional magma that one day would erupt. In the contemporary world events occur which trigger potentially dangerous memories and emotions; the eruption must be stopped at all costs. The result is blind panic, everything gets bottled up again and life, such as it is continues.

There's a problem here. I like analogies, so I'll turn to one here from my hiking days. You're out in wild country and you come across a river in full spate. It's not that deep but the power of that rushing water is tremendous. Your destination requires you to get to the other side. It's too wide to jump across and then is no bridge for miles in either direction. The hard fact: you can't go over it; you can't go under it; and you can't go round it. You have to go through it to reach your destination. The same is true of those buried traumas. There's no way over, under or round them. The only way to health is to go through them and it's going to be no easier and no more pleasant than wading that ragining torrent.

That's why you need skilled, experienced professionals; they are the walking poles that will allow you to keep your balance and get to the other side. That and a load of friends shouting support and encouragement.

There's more than enough to chew on there, so I'll pause now. Next time I'll say a little bit more about this, and then we'll turn to the easy one, situational anxiety.