Stress and Anxiety

Society is suffering from an anxiety endemic. A quick Google search will show you an endless list of articles about how Americans feel more anxious than ever before – especially our young adults – from generalized anxiety to social anxiety, specific phobias to panic disorders. Our guiding framework, Traditional Chinese Medicine, may have some wisdom to offer that could help those of us in Western society deal with our anxiety.

First, let’s clarify the difference between stress and anxiety. Stress is the response your mind and body go through when there is a recognized threat; the Snake Brain sets off an Alarm Emotion that tells you to respond to the threat right now. It’s very natural to feel stress if you’re walking across a rickety suspension bridge or heading into a job interview – in both situations, you have to perform well to stay alive, so stress in the moment makes sense. But what about the stress you feel leading up to the event?

Managing Stress

When you first find out about a stressful situation, your Snake Brain, the part of you that can quickly recognize threats, screams Danger! That sets off an Alarm Emotion. But your Snake Brain has no concept of time, so even if this is a future event that you can still prepare for, your Snake Brain will hurtle you emotionally into the future, as if the event is happening right now. This isn’t helpful; on the contrary, it's a catastrophe because it prevents you from preventing a catastrophe.

This is when we need our Sage Brain, the part that is capable of complex analysis and learning, to step in. Thanks for letting me know about the threat, Snake Brain – I’ll take it from here. Engaging your Sage Brain allows you to think about how much time you have before you have to face the situation, and to formulate a plan so that you are ready to take it on – two things the Snake Brain cannot do. The amount of stress we feel leading up to the event and as it's actually happening can be substantially reduced if we feel prepared.

For example, if you know you have to cross a scary suspension bridge, you can practice on something lower to the ground that you can jump off of if you lose your balance. Or you can build up your core strength to help you maintain balance. In other words, you have time to build mastery. For your job interview, you can do research into the company and the position you’re applying for, and present your previous work experiences to show how they are in line with what they want in a candidate. But these things require planning and forethought, things that can only be accomplished when you have a concept of time, which the Snake Brain does not.

Tackling Anxiety

Anxiety is different from stress. It’s a lingering feeling that doesn’t necessarily have to do with an imminent threat, and sometimes it’s hard to even put your finger on what the threat is (thanks, generalized anxiety). This is what makes anxiety tricky: how can you enlist your Sage Brain to help you problem-solve when you don’t know what you’re up against?

The International Statistical Classification of Diseases and Related Health Problems (ICD-10) defines anxiety as “a period of at least six months with prominent tension, worry [italics ours] and feelings of apprehension, about every-day events and problems.” (I thought about citing the DSM-5, but frankly the definition just isn’t as good. You can see the comparison here.)

Worry – one of Traditional Chinese Medicine’s Alarm Emotions – is right there in the definition. But it’s worry that is persistent and has no specified cause that becomes anxiety. So what should we do?

Dealing with Anxiety the TCM Way

First things first: identify what’s causing the worry. The trouble with the way modern society perceives anxiety is that we think of it as a personality trait that is intrinsic rather than something that has an external cause, but the idea that people worry for no reason doesn’t make sense. Everyone may know your next door neighbor is always tense, or your coworker has a reputation for being high-strung, but they didn’t emerge from the womb this way! We often don’t recognize that there are circumstances in a person’s life that can cause them to become anxious. But just because the root causes aren’t obvious, doesn’t mean the individual is faulty or dysfunctional and doomed to live life feeling constantly on edge.

Remember that anxiety is caused by prolonged worry, and that Worry is an Alarm Emotion. When trying to identify the root cause of the worry – and for this we may have to look years back – we should be asking what caused that alarm to be triggered in the first place, and whether that threat still exists. Under normal circumstances, our Sage Brain evaluates the situation and turns off the alarm as it formulates a plan. (Notice that the problem doesn’t have to be completely resolved before the Sage Brain is able to turn off the Alarm Emotion. The Sage Brain simply needs to signal to the Snake Brain that it’s working on a solution and help is on the way. The Snake Brain is then satisfied that its job is done.)

What sometimes happens is that we never turn off the alarm, even after the problem has been resolved. For example, perhaps your neighbor’s son spent years of his childhood ill, but responded well to treatment and has now been healthy for some time with no threat of relapse; maybe the manager who terrorized your coworker for years retired and he’ll never have to worry about being ambushed with more work ever again. Logically, the reasons for their worry are gone, but  when the alarm has been on so long, sometimes it doesn’t register with the Snake Brain that it’s time to turn it back off.

That Alarm Emotion may also stay on because the worrier never had a chance to engage their Sage Brain to address the threat.

Worry is caused by feelings of helplessness, of feeling like we don’t have the ability to meet our own needs and that we will not receive care when we need it. Sometimes, even though the source of worry has been removed – like in the case of the volatile boss who retired – if a person feels like the solution to their problem wasn’t brought about by their own actions, they can still be left feeling helpless. They believe that if a similar problem were to arise in the future, they would be trapped all over again. In other words, they hold on to their worry, even when the cause of their worry is gone.

Sometimes it seems like there is no reason for an anxious person’s worry. When this happens, you really have to hunt for the cause of the alarm, sometimes searching generations back. For example, when I was 23 years old, I filled out a general health questionnaire as a part of my annual physical. My doctor noticed that I was scoring high on anxiety indicators (“Do you have trouble relaxing? Are you restless and have trouble sitting still? Do you feel nervous, anxious, or on edge?”), so she asked probing questions to see if my feelings were consistent with the circumstances of my actual life.

Life as a 23-year-old working professional without many responsibilities outside of keeping myself alive should not have been causing me these levels of anxiety, my doctor said. “But everyone in my family is like this. Isn’t this normal?” I asked. (No, it’s not normal.) My doctor asked if I wanted any medications for my anxiety. “Um, I’m okay. We’re all like this. My dad and his brothers and sisters all pop valium like Pez, and I don’t want to do that. I’m fine.” I wasn’t fine, I was anxious! And medicating me wasn’t going to help me understand why I was feeling this way.

Perpetual worry of unknown origin is unknown because we lose track of the cause of worry over time. In my case, I came from a family of immigrants twice over, meaning not only had my parents immigrated from the Philippines to the United States, but my father’s parents also immigrated from China to the Philippines. Immigrants without ties to their new community are often in precarious situations. They have no established Care Cycles in their new environment and have to fend for themselves until those community ties are established. From a practical perspective, this means that they can struggle for an indefinite amount of time to meet their most basic survival needs such as food and shelter, unsure of whether they will be accepted by their new neighbors around them.

How was I to “remember” something that didn’t actually happen to me? How could I tell my Snake Brain that I had a solid plan for a secure future and that it could turn the worry off, when I didn’t realize I was experiencing worry in the first place? As far as I was concerned, my feelings were absolutely normal. (And if I’m being really honest, I believed that people who didn’t put as much thought as I did into how their basic needs would be met until the day they died were immature and irresponsible, just like my dad raised me to believe.)

When we can’t identify the origins of our worry, it’s worth considering enlisting a professional to help us dive deep into the past.

To truly eradicate anxiety, we need to create an awareness of our own power and abilities, and identify the resources for help we have available to us. Chronically anxious people need to build a strong connection between their Sage Brain and their Snake Brain so that their Sage Brain can turn off the Alarm Emotion as soon as it blares. Then, rather than getting stuck in a loop thinking, “What if…?” we can be empowered to think, “If this happens, then I can…” and move forward with a solution, after shutting off that pesky alarm.