In a psychiatric practice, anxiety is the most common complaint among patients. But consider how common is it that a psychiatrist facing an anxious patient immediately concludes that the patient is suffering from “Anxiety Disorder” and simply prescribes a pill for the anxiety. The same holds true with patients complaining of depression. No wonder that a consensus is slowly building everywhere but in the pharmaceutical industry that there is an alarming number of North Americans – men, women and children – are over-medicated for pain, anxiety, or depression.
In an ordinary medical practice, pain is the most common complaint among patients seeing their family doctor. For example, when hearing a complaint of pain in the stomach area, the doctor first tries to find out a little more about the pain before making a diagnosis. The doctor will ask if the pain is acute, chronic, triggered by a particular movement or food, whether it hurts when it is pressed here rather than there, and so on. Only after the analysis concerning the source of the pain is made would a diagnosis be made and an analgesic (a pain killer) be prescribed.
Just as many cases of pain can be traced to bad posture, lack of exercise, and lack of mobility in the elderly, many cases of anxiety and depression can be traced to very real experiences of deep trauma.
Life is filled with mixtures of joy and sadness, carefree laughter and deep worries. Joy and laughter are seldom experienced as a problem. But when something in the environment triggers your internal alarm system, you will start worrying. Worrying is not per se a bad thing. It can be helpful in deciding to focus your energy in preparation for a task at hand, for problem solving or securing a level of certainty. However, when worry becomes one’s normal state of being, it becomes difficult to control. It can result in persistent anxiety, loss of sleep and/or raising blood pressure. When worry becomes ongoing anxiety, inappropriate or disproportionate to the object of concern, it is no longer helpful.
Clearly, not all worrying is pathological. For instance, if your teenage son is going out for a casual ride but you suspect that the driver has had a couple of beers, then your worry is perfectly justified. It is an alarm bell going off that is to be taken seriously. But once we have done the necessary scrutinizing of a situation, and ensured that reasonable actions have been taken, worrying is a waste of energy. If that worrying continues to the point of paralysis, it then fits into the psychiatric category of an Anxiety Disorder.
The next question needs to be asked though, “Does that mean that drugs are necessarily the best treatment?” One argument against pharmacological treatment is that while drugs can ease your mental tension, they may also take away the ability to encourage yourself to practice self-regulation while potentially leading you down the path of chemical dependency. Being trained to deal with tension via a quick chemical fix is not particularly that far from the entryway of addiction. In the long run, is this beneficial for you? It is my view that as therapists, we should be encouraging patients to engage in correcting and refining the balance of their internal alarm system through therapy that may include medication as an adjunct but not the sole treatment.
Life is full of obstacles past, present and future. One must beware of relying solely on drugs to protect you. Relying on a drug that helps, without embarking on the necessary internal re-calibration work of psychotherapy, is a mistake. Why? Because you have not used the situation to learn about the root causes of your difficulties in dealing with the obstacles you face. This leads to the ongoing undermining of your own sense of self-empowerment.
If you visit your family doctor because of a pain in your right shoulder, I certainly hope the doctor does not say, “We will open up your shoulder and take out whatever is bothering you.” No, you want the doctor to ask more questions, to further examine the shoulder, and order some tests to find out the real pathology. Shoulder pain can be what is called “referred pain” which can indicate potential pathologies as diverse as abdominal, pelvic, heart and lung problems as well as, of course, a strain or tear in the shoulder muscles. In a similar way, simply treating anxiety or depression without identifying the actual illness or circumstances causing those symptoms is at best lazy medicine and, unfortunately, has the capacity to be far worse.
