Anxiety is often a stimulus for growth, but when it becomes paralyzing, it is termed a “disorder”. On the other hand, no anxiety can mean mental “deadness” and that may represent developmental stagnation. The sweet spot of anxiety is the discomfort on the journey to new challenges, and yet to get to this “sweet spot” is a non-linear path. Medicating anxiety is often helpful, but at the same time, it side-steps the notion that anxiety which is overwhelming is often more a reflection of self-esteem than a problem with “anxiety”. Psychic withdrawals often produce calm states of mind, but at the price of developmental growth. Similarly, addiction is a form of psychic withdrawal, which temporarily relieves anxiety, but long-term causes immaturity and bodily destruction. With this conundrum I am left wondering about our diagnostic system which classifies “Anxiety Disorders” as a condition warranting treatment, as opposed to an “immaturity disorder” which is a condition warranting psychic growth. It is politically incorrect to term those with “Anxiety Disorders” immature, and yet, for the moment, I would like to entertain that notion. Perhaps maturity means a certain calmness in handling life’s irregularities. Perhaps anxiety is a signal to promote growth and development, to help the patient “grow up” and manage life. Perhaps it is wrong to give these folks a medical diagnosis which promotes the sick role, as opposed to a psychological diagnosis which mandates them to develop coping skills.
Chad, fifty-four year old male, comes to mind. He quit his executive job because he was having panic attacks. He now stays home and reads books, while his wife and three children leave the house to go to work and school. He says he is “disabled” by his anxiety, and that “no one” can help him. His “panic disorder” qualifies him for disability, so he receives a monthly check. I wonder what would happen if his panic attacks did not qualify him for disability. I wonder if he would then feel the need to re-boot his life to a job that gave him more satisfaction. Chad is not anxious now and he is not on medication, but then again, he hardly leaves his house on weekdays and his weekends are spent driving his kids around. Is Chad immature by my account? Yes and no. Chad had a good job for many years but when he was passed over for a promotion he felt humiliated and started having panic attacks. He left his job and his symptoms immediately went away. Chad needs to take this humiliation as a step towards finding a new way to be in the world, rather than retreating to a safe, but stifling existence. We, as physicians, should not encourage him to take on the sick-role, but rather we should facilitate him in finding his next career move, by exploring different areas of satisfaction for him. A more positive psychology, one based on the notion that humans want to live in deeper and more meaningful way, would be far superior to a medical model which promotes disability and stagnation.