Shirah Vollmer MD

The Musings of Dr. Vollmer

Growth Vs. Anxiety

Posted by Dr. Vollmer on February 9, 2016

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.

2 Responses to “Growth Vs. Anxiety”

  1. Shelly said

    Is Chad bothered by this “disability?” Does he feel stifled, or is this a term you use? If his panic disorder disappeared when he left his job, then why is he at home? Is it job specific? Was it only that particular job, or any job? Not to criticize you, but perhaps once again, you are putting your standards on Chad, and perhaps Chad likes living this way? Perhaps he enjoys and benefits from being the identified patient?

    • Chad is not bothered by his “disability” most of the time, but in rare moments, he is disturbed by his situation. It is as if the boat has a small leak which will eventually sink the ship. He is at home because he has a diagnosis which leads to monthly checks. The panic attacks seemed to follow humiliation at work. It is always a tricky question about whose values should Chad, in this case, live up to. The evidence that Chad is not happy with his situation is his lack of vitality and creativity in his life which used to exist before he had panic attacks. He has transformed from a vital man with lots of energy to a man who has a much smaller footprint on his world. It appears that his constriction is a compromise between being vulnerable to humiliation versus his ability to think and act creatively in his job. The idea is that he no longer suffers from anxiety, but at the same time, he also no longer creates new ideas and strategies which make him feel invigorated. His deadness is a compromise that I challenge him on and that he responds positively with acknowledgment that he has the potential to explore life in a more vigorous way. Thanks for challenging my ideas, as always.

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