Anxiety and stigma

I am mentally ill.

I say it that openly, and that bluntly, for a reason: mental illness still has a significant and entirely undeserved stigma in our society, a stigma shared by virtually no other group of illnesses.  I've never heard of someone ashamed to say they have bronchitis, high blood pressure, arthritis, heart disease, or cancer.  While no one would question the gravity of any of those or the impact on the patients and their families, none of those carry the same sense of shame -- the underlying feeling that somehow, it requires an apology, that it's the sufferer's fault for "not trying hard enough."

"Suck it up and deal."  "Just focus on the good things."  "Let go of the negatives."  All, perhaps, well meant, and all entirely useless.  Whatever the underlying cause of the anxiety and depression I've battled my entire life -- whether they're from a neurochemical imbalance, a genetic predisposition (there is good evidence that depression, at least, runs in both sides of my family), trauma from the emotional abuse I endured as a child, or all three -- what I experience is just as real as any symptoms coming from a purely physical illness.

I've gone to hell and back trying to find a medication that helps; none of the standard meds made much of a difference, and several gave me horrible side effects.  Right now the depression is reasonably well in check from the combination of the compassion and support of my family and friends and a set of coping mechanisms (exercise being top of the list).  The anxiety is tougher because it can come on without any warning, and is often triggered by activities that "should be positive" -- getting together with friends, engaging in creative pursuits, even leaving the house.

Edvard Munch, Anxiety (1894) [Image is in the Public Domain]

The reason this comes up is a pair of studies I ran into last week that resonated so strongly with my experience that I found myself saying, "Why didn't the researchers just ask me?  I coulda told them that."  The first, that appeared in the International Journal of Psychophysiology, investigated fear responses -- specifically, how quickly startle reactions ceased once a person realized something surprising wasn't actually a threat.  What they did was show test subjects photographs of two women, then suddenly substituted one with a photograph of a woman showing fear and accompanied it by the sound of a woman screaming at 95 decibels, delivered through headphones.  (I'm so sound-sensitive that just reading about this made me anxious.)  What was fascinating is that (of course) all the test subjects startled, but the ones without anxiety disorders very quickly learned that it wasn't a threat -- on repeated exposures to the same stimulus, they stopped reacting.  The people with anxiety disorders didn't.  Every time the photo changed and the scream came, they reacted, even when they knew it was coming.

This is all too familiar to me.  I once lamented to a therapist, "Exposure therapy doesn't work on me."  I have dreadful social anxiety; I take a long time to open up to people, and when I'm in a large group I tend to shut down completely.  I've been at parties where all night long, I've said exactly two sentences: "Hi, how are you this evening?" and "Good night, thanks for inviting me."  It doesn't seem to matter how many social gatherings I go to where nothing bad happens; I still get overwrought the next time, and spend the lead-up to the event hoping like hell there'll be a dog there to socialize with.

The second study, that appeared in the journal Behavioural and Cognitive Psychotherapy, looked at the ways that people with social anxiety cope, and found that those same "safety behaviors" -- such as rehearsing ahead of time what they'll say, avoiding eye contact, shying away physically if they feel like they're in the way, and not talking unless spoken to -- cause others to perceive them as less likable, more standoffish, aloof, and superior, and less authentic.

Which, of course, is the most vicious of vicious cycles.  I know I do all of those things, not to mention finding an excuse to leave early.  I also have a tendency to get tongue-tied when people do speak to me directly, which probably is why in short order they decide that they'd be better off finding someone else to chat with.

Both studies had me saying, "Yeah, exactly."  Even so, I'm glad these sorts of papers are appearing in well-respected journals.  All of it is a step not only toward finding out what underlies mental illness, but toward reducing the stigma.  Sufferers from disorders like depression and social anxiety aren't simply weird, and we're certainly not doing it for attention (something I was accused of pretty much continuously when I was a kid).  We're just struggling, in the same way that someone with a physical illness might struggle.

I have some hope that the stigma is diminishing.  I've been heartened by the support Senator John Fetterman of Pennsylvania has received following his revelation that he was entering the hospital for treatment for clinical depression.  We still have a long way to go -- there are still people who look at Fetterman's actions as evidence of weakness or instability -- but far more are responding with empathy, with an understanding that we sufferers from mental illness are every bit as deserving of compassionate care as someone dealing with any other kind of illness.

And while understanding that won't cure us, it certainly goes a long way to making us feel like we're not so alone.

(IMPORTANT NOTE: if you, or someone you know, are considering self-harm, please call the Suicide Hotline number now.  The number is 988, and there are people there who can help you and provide the emotional support you need.)

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Dentophobia

I only have one real phobia, and that is: dentists.

I know where this phobia came from.  My childhood dentist, Dr. Webre, was not of the kind, gentle, "you seem to be uncomfortable, do you need more Novocaine?" variety.  Dr. Webre graduated from the Josef Mengele School of Dentistry.  Once, when I was about nine years old, he was filling a small cavity, and I could still feel the drill.  I tried to man up, and was doing my best not to scream, but evidently I flinched a little.  Dr. Webre's response?

"Stop that jerkin' around, or this drill is going to go right through your face."

He said this to a nine-year-old child.

I know, as an atheist, that I don't believe in hell, but I'd almost be willing to revise my belief system if somehow it would mean that Dr. Webre was there.

Oh, and I haven't mentioned that when he removed my wisdom teeth, he broke one of them.  Into three pieces.

So, like I said, it's kind of understandable that I have an absurdly powerful fear of dentists.  I start feeling nauseated about a week before an appointment, and it doesn't go away until I'm in the car driving home afterwards.

[image courtesy of the Wikimedia Commons]

Doctors have made great strides in treating deep-seated phobias.  The trick is disconnecting the limbic system fear-response from whatever the stimulus is, and is often accomplished through a combination of medications and exposure therapy.  The problem is, exposure therapy means... exposing yourself to the cause of the phobia.  In my case, it was much easier just to avoid the whole thing and hope that my teeth wouldn't fall out.

Now, let me say up front that my current dentist is awesome.  He has this wonderful thing called "sedation dentistry" in cases where you need something major done.  You not only more or less sleep through the entire procedure, you don't remember anything afterwards.  I saw this work wonderfully when my younger son, Nathan, had his wisdom teeth extracted.  Nathan was given a combination of diazepam and triazolam prior to going in.  You might be wondering what these two drugs are, so allow me to explain that the difference is that diazepam has two azepams, while triazolam has three azolams.

Okay, I admit, I have no idea what those drugs are.  But they were amazing.  When Nathan came out of the dentist's office after the extractions, he was showing the level of agitation normally associated with lobotomy victims.  On the way home, he had to exert all of his effort to avoid drooling on the upholstery.  He went right to bed, woke up five hours later, and had no memory of any of it, then or since.

So I'd seen the whole thing work splendidly, but I still couldn't bring myself to go in.  My feeling was that I'd have needed some diazepam and triazolam just to be able to make the phone call and make an appointment without fainting or throwing up.  But last month, I realized I had to do something, because one of my teeth was kind of sensitive, and I was worried that if I didn't get it checked I was probably going to regret it.

So I called and made an appointment.  The only way I was able to do it was that I kept telling myself that (1) I could cancel it if I freaked out too badly, and (2) Dr. Webre wasn't going to be there, cackling and rubbing his hands together maniacally, when I got to the dentist's office.

I made it through the following month, barely.  The nightmares started about a week before the appointment.  I couldn't concentrate on anything but the thought of OH DEAR GOD I HAVE A DENTAL APPOINTMENT IN A WEEK.  Then it was the day before, and the day of, and a sort of gallows-hilarity descended upon me.  Yesterday, during my classes, I had this frenetic, hysterical energy.  "Ha ha!" my brain seemed to be saying.  "May as well laugh, given that you're going to die in five hours!"

I know that this may all seem ridiculous to my readers who aren't phobic about anything.  But I am not exaggerating when I say that anyone who has a phobia about something they have to deal with on a daily basis -- like going outside, or the dark, or insects -- must truly exist in perpetual agony.

Anyway, I drove to the dentist's office, was welcomed warmly by first the secretary and then the hygienist, and taken into the examining room.  And...

... everything went fine.

My sensitive tooth turned out to be a little bit of root exposure from receding gums.  The hygienist and the dentist both said that it was nothing to worry about, that it could be treated with a sensitive-teeth toothpaste and a fluoride rinse, and failing that, the spot could be sealed with a simple procedure that takes about 45 minutes and doesn't even require Novocaine.  Everything else about my mouth was fine, which shocked everyone given that the last time I'd been in the chair was fifteen years ago.

Dumb luck, sometimes, is a wonderful thing.

So they made me promise to come back in a year for a cleaning.  I said I would, and I think I was being honest.  As exposure therapy goes, this one may have been fairly successful.  I can only hope that next year, I won't go through the agonizing four weeks between phone call and appointment, picturing every possible worst-case scenario my limbic system can dredge up.  I think, actually, that I won't worry very much at all.

Take that, Dr. Webre.