The aim of this post is to give you a preamble as to what is behind the diagnoses of anxiety disorders.
‘Too Much Anxiety’
People quite often talk about anxiety as a medical disorder in everyday language. This is because they have been taught by the medical establishment (and pharmaceutical advertising) that anxiety can be a mental disorder if you have too much of it. Notably, having too little doesn’t seem to merit the same consideration, which is interesting given that anxiety is argued to be a human’s core self-preservation mechanism. In any case, the judgement underlying ‘anxiety disorders’ is to say that if you have too much anxiety such that you cannot function in society, then you have a mental disorder that should require ‘expert’ treatment.
‘Philosophical Problems with The Idea of ‘Anxiety Disorder’
The problems with the kind of thinking above are extensive. For one, the judgement of who has this disorder is left to diagnosticians (doctors, psychiatrists, psychologists etc.) and their ‘clinical judgement’ alone. But how can a physician or clinician truly know how you feel or what you’re experiencing? Outside of having an objective test for such diagnoses (which they do not), they rest their case on having some form of expert training in deciding who should qualify for a diagnosis of anxiety as a medical condition. Their training can be wrong, of course because without evidence, you could invalidate a diagnosis of anxiety disorder by simply disagreeing with it. Put simply, the medical world is teaching people that anxiety is a medical disorder but with no evidence supporting it aside from someone reporting that they have anxiety. This may seem uncontroversial to you, but generally speaking, an oncologist (cancer doctor) does not diagnose a condition without objective biological evidence supporting their theory. You could disagree with an oncologists diagnosis, but it would be difficult to disagree with the tests that show disease. Conversely, with anxiety, a person could arrive in a physician’s office, state they’re anxious and this could warrant a diagnosis and treatment (usually drug(s) to ‘treat’ it. Of course this all depends on the doctor a person visits, as some doctors have detected the non-trivial philosophical issues with diagnosing anxiety a medical condition.
Symptoms, Not Causes
The above means medical jargon qua diagnosis such as ‘obsessive-compulsive disorder’, ‘generalized anxiety disorder’, ‘panic disorder’, or ‘social anxiety disorder’ are said to be official diagnoses for various anxiety conditions but are grounded without evidence. Instead, the words used in the diagnoses just describe symptoms. ‘Generalized anxiety’ explains what a person might be experiencing, but says nothing about why this person is experiencing it (cause). The same goes for ‘obsessive-compulsive disorder’ and the others that I have used as examples. A person who has a panic attack is said to have ‘panic disorder’ which appears logical, but says nothing about why they had the panic attack. Think about cancer as a comparison. A person with Hodgkins lymphoma (cancer) is said to have this disease because of biological evidence. An oncologist would not just diagnose someone with this condition from a simple office chat. In the case of cancer, the cause might be unknown, but at least the biological basis for it drives the diagnosis. Indeed, with panic disorder (or the other anxiety disorders) we know what the biological basis is (self-preservation mechanism firing), but the problem is that it requires a subjective judgement coupled with a failure to acknowledge or aim at causation on the part of a clinician to generate the conclusion. Foregone in this case, I argue.
The Power and Economic Structure of Anxiety Disorder
If you have a diagnosis of an anxiety disorder, then you might qualify for time off work, health insurance, counselling etc. The current medical system is designed to pin such things as insurance benefits to having an official diagnosis. But who does this actually serve? If the attitude towards anxiety is that the symptoms of it warrant a diagnosis and medication(s) or other therapies, then there is extensive money implicated with this kind of system. Without such diagnoses, the system would not have a consistent measuring stick to judge who is worthy of benefits or care and who is not. Notably, various industry (yes, mental health is a business) associations are making statement such as ’40 million Americans have an anxiety disorder’ or ‘anxiety disorders are the number one mental disorder’ in society today. Why and how could so many people have such conditions? 50 years ago, this was unheard of. The answer is that in 1980, the psychiatric establishment decided to publish a diagnostic manual that included the famous anxiety disorders that are now in common language today. There was no great reason for it, the authors now say that they used the ‘BOGSAT’ (‘bunch of guys sitting around a table’) method to rule on their addition.
What is notable though about the left turn psychiatry took in 1980 is that the focus on anxiety was shifted to symptoms and not causes. And since the tack in the medical world is to diagnose symptoms as causes (or perhaps they make this mistake on purpose), then it stands to reason that a lot of diagnoses serve the interests of the therapists and the medical system as it underpins a revenue model that generates clients.
A Hint Towards the Truth
The truth about anxiety is that it is environmental by cause. Only one diagnosis of anxiety, ‘post-traumatic stress disorder’ acknowledges environmental causes, but anxiety is, in fact, anxiety and not to be confused with the diagnostic concepts that the medical world has constructed. And if anxiety is rooted in environmental causes, then this means it is also rooted in social causes, which I will explain in another post. Why package anxiety as a genetic/biological disorder and diagnose it as such? I’ll touch on this in-depth in another post.
The problem with diagnosing symptoms and not causes is that it is an insincere way of going about things. For instance, ‘generalized anxiety disorder’ might be better understood as ‘bully boss and toxic work environment’, ‘abusive spouse’ or even ‘chronically ill child’ disorder(s). Indeed, these kinds of life circumstances would logically lead someone to be chronically anxious or even depressed. But this means that the acute anxiety is actually expected or normal, not disordered or dysfunctional as is the sentiment from relabeling each a specific disorder. The difference though, is that telling someone they have a medical disorder is akin to telling them that the problem ‘is their brain’ or that ‘it is their problem, that they should be able to cope given their circumstances’. This is artefact of the ideological focus of extreme individualism that is currently cherished in contemporary society (which I will also touch on in another post). The message from diagnosis though is that if you have a problem, then it must be you and not the outside world. Only some practitioners acknowledge this and withhold judgement on diagnosis and treatment on the basis of ensuring that they do not further victimize a victim.
At Annapurna, we’re not interested in diagnosing people with anxiety. They come to us because they know they have it, we don’t need to repeat it back to them. What interests us is what is at the root of it; how to educate people such that they make informed choices about how to deal with anxiety; and to empower them to live the life they want despite anxiety. They might find that the medical world and their way of doing things works, or they might believe that ‘alternative’ methods are useful. We aren’t arguing that there is a ‘right’ way to go about this. The point here is, we focus on educating people to offer a full disclosure on the nature of anxiety and the ethics of treatments. Once someone has gained a well-informed view on why they have anxiety and what they can do about it, then they will learn to empower themselves to move through it.