CHAPTER 7
Georgia was a young, intelligent and capable woman aged in her late twenties who worked in marketing. Although she had a long history of low-level anxiety, part of which she had inherited from her parents, it had never been enough to interfere significantly with her life—until six months ago. Recently life had become more demanding at work, as well as socially and at home. Her sleep had become affected in part due to an irregular lifestyle and the various energy drinks she used to boost her flagging energy levels, but also in part to an increasing tendency to worry. Then six months ago Georgia had her first panic attack, out of the blue, while driving her car. This shook her up and she started to anticipate the possibility of another attack in an even more public place. Sure enough, such an attack did come on while she was at work. Although everyone was very understanding and sympathetic, Georgia wasn’t so gentle on herself. She became hyper-vigilant for signs of anxiety and when she experienced them she tried desperately to make them go away. Unfortunately this didn’t make them go away; in fact, it made them all the worse.
Over the next couple of months Georgia’s panic attacks came more frequently and stronger, to the point where she was experiencing them on and off for hours in the day. She couldn’t leave the house, couldn’t work, couldn’t socialise and her life became isolated and bleak. After another couple of months it was apparent that wishful thinking wasn’t helping, nor was a growing sense of helplessness. Georgia saw her GP, who did some tests to be sure there was no major physical illness to explain the problem, which there wasn’t. Georgia said that she wanted to learn to manage the problem herself and didn’t want to go on sedatives or other medications because she felt, with her personality, she would be addicted in no time. Her moment of facing up to her demons had come...
Have you ever been anxious? Have you ever wondered what really causes your anxiety? Let’s consider what anxiety is—from a mindfulness perspective—and whether there’s something we can do about it. It might seem radical, but we can even consider the possibility that it’s possible to make anxiety, and the deep human suffering that underlies it, disappear into irrelevance.
According to the ancient Indian wisdom tradition of Ayurveda (‘ayur’—life; ‘veda’—wisdom) anxiety is the cause of all of our health problems, mental and physical. That the mind profoundly influences our health is not a new concept, although the increasingly popular field of research called mind–body medicine can make it sound like it is. The research by Elizabeth Blackburn and her colleagues that we described in the previous chapter, and the research of Herbert Benson and his team at the Harvard Mind–Body Institute, show that our stress genes can be accentuated by poor living and quietened down by mind–body techniques such as meditation.[1] This demonstrates the profound practicality of science meeting life, in this case the science of epigenetics. How’s that: tweaking our genes with our mind and attention. What next?
One of us once did a fifteen-day Ayurvedic treatment in a small, humid and dusty Ayurvedic hospital, in a small, humid and dusty southern Indian city called Quilon. During his initial week as an Ayurvedic outpatient he spent several hours every morning waiting for his four-handed medicinal oiling and oral herbal treatment, in a very appropriately named waiting room. On the waiting-room wall facing him was a painting of a serene blue god holding what looked like a pitch fork. This was the great Hindu deity Shiva.
‘What’s he doing here?’ he eventually asked one of his impending oilers.
‘Shiva is god of destruction and medicine.’
‘Um, isn’t that an odd combination?’
‘No! To be healed you must first destroy what is not true!’
Shiva is symbolic for consciousness so perhaps that has something to do with healing. According to Ayurveda, anxiety comes from feeling separated. We can see ourselves as separate from our community, or from our family, or from the human species, or from our idea of what we would like to be, or from anything. It doesn’t much matter what we think we’re separate from, if we think we’re separate, instead of being ‘at one with everything’, then our idea can fill our world with lots of potential competitors and threats. Of course, our anxiety may also be related to being asleep, metaphorically speaking.
Curing anxiety may be quite simple, conceptually at least. But just because it’s conceptually simple doesn’t mean that it’s practically easy. It will take a fair bit of effort and a fair amount of courage, but if we’re up for it then mindfulness may be just the thing we need—to see the cause and to apply the remedy. Popping a pill (prescribed or unprescribed) seems easy but it will at best only cover up the symptoms, leaving the cause unexamined and, sometimes, make the problem worse.
On one level all we need to do to be free of our anxiety is to restore our natural connectedness—unity. To do this we just need to be mindful, rather than mindlessly feeding the kind of ruminative patterns that makes us feel separate. Anxiety can be seen as modern mass mindlessness, which isn’t just a personal affliction. Anxiety is a condition that can affect whole societies and entire ages, and this current age is pretty good at generating and perpetuating anxiety. A society is just like any person in it, who can get mentally and physically sick when they get so distracted by their desires that they forget what makes life truly valuable—living consciously, which simply means being present and awake.
Let’s look at the separation issue first. Western psychiatry actually has a similar slant to ancient wisdom traditions on why people develop anxiety and anxiety-related illnesses: we get anxious when we lose sight of our centre or sense of true self. Developmental psychology also adds something to the growing non-denominational wisdom database. At the age of about eighteen months we develop a sense of being a separate ego, which leads us to what the philosopher Neale Donald Walsh called our actual original sin—self-obsession or thinking about our (separate) selves. Connection is very important at any age, but particularly in our early developmental stages. Dan Siegel, a child psychiatrist, writes at length about this in his book The Mindful Brain.[2] We can see the potentially self-destructive loss of our wisdom of knowing who we really are as the delusion of thinking, rather than being. We literally start to think our way out of our connection, out of our present moment and out of happiness. It might not be a coincidence that we develop our sense of a separate self and language and possibly also time at about the same age.
The idea that we create a false and separate sense of self, and that we get anxious when we lose contact with our true self, might even be a missing link between psychiatry, psychology and philosophy—and between ignorance and knowledge.
So what then can we do about our anxiety? Nothing. That might sound a bit defeatist but it isn’t. Our experience with anxiety will have taught us, again and again, that the more we fight it the more entangled in it we get. In a paradoxical kind of way, learning to notice the physical and emotional experiences associated with anxiety in a more mindful way teaches us a few basic truths. First, these experiences are transient—they come and go. Second, they come and go more easily when we don’t get so reactive to them or fixate on them.
Mindfulness practice could be seen as an effortless action that links our experience and knowledge, and our surface and deeper selves. The result of this reunion with reality is that we don’t have to do anything to heal ourselves or to be ourselves. We can learn just to be content with what is. If we can simply become fully aware of what actually is, of who we actually are, then we can lose our preoccupation with what isn’t, and what we aren’t. We can therefore experience reality without thought or mood, and reunite with the deep peace that our natural state consists of. The trick to finding peace is all about learning to be at peace with our moment-by-moment experience.
Now for the being-awake issue. As we discussed in Part 1, when we are daydreaming and distracted—whether about what we imagine the future to be or the replays we have packaged from the past—we create a world of imaginary stressors, and our body activates itself in response. The loss of capacity to distinguish between our imaginations and reality leaves us tremendously vulnerable to anxiety and depressive rumination. This world in our head tends to lack perspective, rationality or stability. The more we elaborate on it the more complex and convoluted it gets. Mindfulness is the gateway out of this dark and threatening internal world and into the fresh air and daylight of reality. It’s a form of metaphorical and literal waking up out of our internal dream and into the clear space of the present moment. Life is no more complicated or threatening than the thing that’s happening right now. If we pay attention in the present we will find that 99 per cent of the time we are getting anxious when there’s nothing much happening—just making a cup of tea, sitting on a train, lying in bed, waiting for an appointment. Our senses are the gateway into the present moment—see, hear, touch, taste, smell. We have to come to our senses if we want to transcend anxiety.
A possible fringe benefit as well as a possible cure of anxiety is the realisation that no matter how anxious we think we are, we’re not alone. There are a lot of anxious people out there, thinking that they are alone. The United States has approximately half of the world’s psychiatrists, as well as approximately half of the world’s lawyers. A central principle of statistics is that association doesn’t mean causation, because there might be something happening at a deeper level that’s actually causing both associated phenomena—in this case psychiatrists and lawyers. It might be interesting then to consider what could be simultaneously causing the proliferation of both psychiatrists and lawyers, and maybe anxiety is the common denominator.
There are over 40 million adults in America diagnosed with an anxiety disorder, often by psychiatrists. This means one in five American adults is clinically anxious, and the figures aren’t a lot different in other developed countries. What sort of a world are we creating for ourselves? There are many more people who haven’t been officially diagnosed with anxiety, so 20 per cent is just the tip of the iceberg. Psychopathology isn’t a binary condition that you either have or you don’t—there are levels of affliction. We can all have the same problem to a greater or lesser extent. The question is, whether we’re an individual or a country, which direction are we heading in—are we moving towards more anxiety or less?
Rates of anxiety differ greatly in different societies, which might say something about its cause. Perhaps surprisingly, anxiety rates in traditional communities or less developed countries are extremely low. Anxiety rates in large cities worldwide are, however, far higher, which suggests a grass-is-greener attitude that leads people in many countries to leave their small societies and travel to big cities. Perhaps this attitude of always looking for something better or bigger explains the ‘progress’ of societies, into psychopathology. People are usually happy in traditional societies because they mainly know what’s expected of them and they naturally feel connected to their communities. This is simple when you and your family have been in the same place for 3000 or so years. It’s easy, however, to feel cut off and alienated and anxious when you’ve just arrived in a city of mega millions. Being connected actually means a lot more than just having lots of people around us.
There are numerous treatments available for anxiety and, as with most things, some of them work better than others do. As usual, treatments tend to be based on underlying theories. Some important theories that underlie common treatments for anxiety include the behavioural and learning model, the cognitive model, the psychodynamic model and the physiological model.
A common psychotherapy for treating specific phobias is systematic desensitisation. This isn’t as painful as it sounds, usually, and involves pairing scary stimuli such as spiders, snakes and dentists with nice stimuli, such as feelings of relaxation and self-mastery. This is done bit by bit, for example starting off with showing a snake-phobic client a rubber snake and then encouraging them to feel relaxed with it. Eventually the phobic client may be presented with a gradation of increasingly challenging situations, all the while pairing the relaxation response with it, for example ending up cheek to cheek (or whatever) with a real live python. This treatment arose from the association and conditioning learning models that see anxiety as a learned or conditioned response. Whatever has been learned—and wired into the brain—can be unlearned and unwired again.
Another common psychotherapy for treating anxiety is Cognitive Behavioural Therapy (CBT). This involves encouraging people with clinical anxiety to examine and eventually improve their destructive thinking habits that cause and perpetuate their anxiety. For example, ‘If Jane/John doesn’t agree to go out with me when I ask her/him tomorrow then I will probably end up alone—forever! Contemplating life without Jane/John, whom I met two days ago, is so utterly devastating that I can feel myself freezing with anxiety—which Jane/John will surely notice and then reject me! I’m a nobody if she/he won’t go out with me!’ CBT derives from a cognitive behavioural model that emphasises the relationship of our thoughts to our behaviours and emotions, including anxiety. In CBT one would examine, question and challenge these kinds of thought patterns.
Psychodynamic therapies for anxiety consist of working with clients to identify the underlying reasons for anxiety, such as past events or relationships, that haven’t been adequately resolved. These therapies originated in the psychoanalytic theories of Freud, who saw all behaviour, and especially maladaptive behaviour, as strongly influenced by unconscious conflicts.
Drug treatments for anxiety consist of a direct and immediate response to a highly aroused physiology, involving the administration of drugs such as sedatives or tranquilisers. This approach has been accused of conceptualising anxiety as being treated only at the level of its symptoms, as if it doesn’t have a deeper cause that can be understood and treated. Drug therapy for anxiety can cause more problems than it cures because taking anti-anxiety medications can make people feel tranquilised, they can be habit-forming, and if the underlying causes aren’t addressed they can make people’s lives feel like emotional rollercoasters of uncontrollable ups and downs. This contrasts with non-drug options such as mindfulness that can make people’s lives steadier.
Mindfulness could be seen as a response to anxiety that involves changing our behaviour at its causal level. There’s vast and longstanding experimental evidence that demonstrates that meditation-based practices such as mindfulness reduce anxiety.[3] Indeed, this was one of the first conditions that meditation and mindfulness techniques were scientifically shown to be effective for. Scientific research was undertaken in the late 1960s and early 1970s into the benefits of meditation techniques such as Transcendental Meditation (TM), which clearly demonstrated their substantial anxiety-reducing benefits. Objectively measurable benefits of TM such as stabilisation of irregular heart rates, changes in blood pressure and reductions in adrenaline were found although experience had demonstrated these benefits thousands of years ago.
A key pioneer of modern mindfulness as clinical therapy, Jon Kabat-Zinn, published the results of an important early study of the effectiveness of mindfulness that he undertook with colleagues in 1992.[4] The results of this study showed that the group administration of an eight-week mindfulness training program significantly improved the symptoms of 90 per cent of participants, who were all diagnosed as suffering from either generalised anxiety disorder or panic disorder. The participants’ improved anxiety levels were maintained at three-month follow-up testing, and also after another three years, when the researchers found in a follow-up study that most of the participants were still practising mindfulness.[5] Indeed the depth of the benefits offered by the practice of mindfulness extends to improvements in brain activation pattern and antibody levels.[6] More recent research shows that mindfulness not only helps people’s mood to improve but it also quietens the stress/anxiety centre of the brain, called the amygdala.[7]
A recent study used a meta-analysis to pool the results of 39 separate scientific studies of the effectiveness of mindfulness-based treatments for a total of 1140 people with anxiety and mood disorders.[8] A meta-analysis is basically a statistical melting pot into which meta-chefs throw the results of many individual studies so they can boil them all down into one large result. The results of this statistical feast clearly showed that mindfulness improves anxiety and mood in cases that most obviously need improvement. The results of 39 studies into the relationship of mindfulness to anxiety can be succinctly summarised as: mindfulness reduces anxiety.
So what can mindfulness offer you if you are experiencing a level of anxiety that’s making your life feel worse than it needs to be? What can it offer you if you are free of anxiety and would like to stay that way? Being mindful simply means being with what’s actually happening right now in your life, and not ignoring it by trying to replace it with something in your imagination whether it’s better or worse.
There is a story about a man who goes on a long journey. He comes to a huge chasm and the only way to cross it is via a swing bridge. Just as the man approaches the bridge, out from behind some bushes jumps an ugly, fierce-looking ogre. The man reels backwards and the ogre steps forwards, and as it does it gets even bigger. The man steps back further and the ogre steps forward and gets bigger again. The man keeps going further and further back and the same thing keeps happening. By this time the ogre is huge and about to grab hold of the man and devour him. At this point the man has a (most welcome) mindful moment and notices what’s happening. He says to himself, ‘Well, I keep stepping back and the ogre keeps stepping forward and getting bigger. I’m just about done for, so I’ve got nothing to lose. I wonder what would happen if I stepped forward?’ The man stepped forward and to his surprise and relief, the ogre stepped back and got a little smaller. Encouraged, he kept stepping forward, and the ogre kept stepping back—until eventually the man was on the verge of the bridge. By this stage the ogre was small enough to fit on the end of the man’s finger, so he picked it up. He was curious about what this creature was so he asked the ogre for its name. The ogre replied in a small, squeaky voice, ‘My name is Fear!’ The man blew fear off the end of his finger and continued on his journey.
There are a few lessons in this story. The first is that avoidance is like stepping back—the fear steps forward and gets a bit bigger every time. We don’t escape from it but we actually confirm the fear and reinforce the thoughts, feelings and behaviour that are reinforcing it. The second lesson here is that we have to accept where we are and pay attention to our experience and not turn away from it. What is our experience trying to teach us? We should be interested and welcome what’s happening so that we can look at it and therefore understand it. Mindfulness will help us to do this—not just while we’re sitting in the chair doing the formal practice, but more importantly when we get out of the chair and go about our daily life.
Anxiety is based on some habits concerning the way we think and how these habits affect our body. The greatest challenge to living life mindfully is the habits that we can mistake for our life. Sometimes our habits mainly consist of us getting into difficult situations and then responding to them difficultly, such as with anxiety rather than with acceptance, or with learning enough about life’s accidents to not mindlessly repeat them. Our habits can get so deeply entrenched in us that they affect our body and mind at a cellular or structural level. Anxiety, therefore, is a habit that can be even more destructive and unconscious than smoking or taking drugs. How then do we use mindfulness to break our anxiety habit?
To begin with, it’s unhelpful to get anxious about anxiety. Paradoxically, often the best way to improve something—to restore naturalness to what’s become unnatural—is to accept it. To get less anxious we need to accept that there’s something going on in our life that we’re not comfortable with, that we’re not mindful of, and this can help us develop insight into what’s causing our anxiety. The ancient Greek philosopher Epicurus said that this is a key to our being happy: knowing what it really is that’s making us anxious. Maybe this isn’t our new job or spouse or prison sentence. Maybe it’s actually something far deeper—a fear of being found out, of being exiled, of being alone. All fear is really just the fear of us losing our individual idea of ourselves, which is what we think death is, so to break our fear cycle we need to realise who we really are and what we really want.
Every time our mind wanders off into its own world of rumination or worry, or we notice our body switching on the stress response, we need to see what’s going on and come back to our existential ‘terra firma’—that’s another way of saying coming back and getting in contact with what’s in front of us, now. To fight with our anxious thoughts and feelings and to try to suppress them is to reinforce them. So let’s be matter-of-fact about them. Let’s be nonchalant about anxiety.
Our biggest fear is of losing the things we’re attached to, whether it’s an idea we hold about ourselves or a possession, or anything else. If we didn’t have all of these attachments then there would literally be nothing to fear. This is sometimes called non-attachment. We can hold on to all of this stuff if we want to but at least we should notice the cost that this brings. At least our holding on to it will be a conscious decision rather than an unconscious habit. Of course, if we do examine what’s going on we will more than likely notice that letting go is the better choice.
Mindfulness can help us to see ourselves in the world of mirrors. The mindful state of simple awareness and acceptance is our truly connected state, and this is a state of love. Love isn’t clinging, because clinging breeds fear. Love is all we have left when we finally let go of our fear. The Canadian poet/singer/songwriter/monk Leonard Cohen once described love as our engine of survival. Being mindful means accepting what’s happening right now in our life, including the sensations that we are experiencing right now; sensations we don’t have to label as anxiety or anything else.
There’s a psychological model of emotion known as the ‘two-factor theory’.[9] This states that our emotions have two components: a physiological state, such as of high arousal, and also a pattern of thinking that appraises that state. We might therefore think of our physiological state as being one of ‘excitement’ or ‘anxiety’ depending on our thinking habits. The relevant point here is that a physiological state is just a physiological state—sensations are just sensations and aren’t a problem unless the mind gets involved and thinks they are. Mindfulness trains us at both a psychological and, eventually, a physiological level to not overreact to what happens in our life and to simply live.
Georgia was very diligent, courageous and faithful in her formal meditation practice. For over an hour a day she practised not fighting with the feelings and thoughts of panic, which wasn’t easy considering how long she had practised fighting against them. She also practised being more present and taking a more accepting attitude towards her day-to-day experiences. Over the first week her major insight was that the anxious feelings that she thought would come and never go did come, and also went—they were transient. By the second week she was getting the knack of not fighting with or resisting them and was curious to notice that this led to them not escalating so much. By the third week she wasn’t feeling the need to try and get rid of them and was gaining confidence that she could ride these waves of panic rather than be swamped by them. She was welcoming the very thing she had been resisting because it gave her the opportunity to learn how to relate to it in a different way. By the fourth week Georgia was disappointed. The panic attacks weren’t coming anymore. There she was waiting in the water with her mindfulness board ready to surf and there were no waves. Georgia was one courageous and determined young woman.
Not so helpful
• Get anxious about anxiety.
Helpful
• Trace the cause of anxiety to its source and develop insight into what’s actually making us anxious.
• Stay aware and accepting of what’s really happening—right here, right now—inside our body, no matter what’s happening outside of it.
• Stay in close contact with our deeper self as the witness of what is happening, rather than identifying with the happenings.
• Be patient with ourselves and let the mindful process work.
• Consider doing a mindfulness course or some mindfulness-based therapy.