Generalised anxiety disorder (GAD)
Hello old friend! Generalised anxiety disorder is sort of exactly what it sounds like – a free-floating but excessive level of worry which can’t be shrugged off. Nearly six people out of 100 are thought to suffer from generalised anxiety disorder in this country,[33] and DSM-5 (the fifth edition of the most popular diagnostic system for mental disorders in the US) says the period of time a person suffers for before diagnosis is important – it puts it at at least six months, to highlight the difference between those with worries based on something specific in life, and those for whom worries will not pass no matter what happens. This kind of anxiety means you worry even when there’s nothing actually wrong, or in a way that’s disproportionate to any actual risk. When you get on top of one worry, another will pop up – and your mind always races to the worst possible scenario in each case.
These worries will nearly always have a physical effect too. You may ‘feel’ a sense of doom, have headaches, suffer from insomnia or feel tired or rundown all the time. Other fun results of GAD that I’ve experienced include a terrible short-term memory; difficulty concentrating on anything; and a massive sense of irritation, directed at myself and others. There are countless other symptoms, which I still sometimes look up on dubious medical sites as a special treat (I’m kidding: I do it to tick off any weird pains I have). The disorder affects women more than men, and it’s a contributing factor in some cases of depression too, hastening the need for treatment.
Much is written about stress in the modern world. The Office for National Statistics says an estimated 137.3 million working days were lost due to sickness or injury in the UK in 2016, and that a third of those days were lost to mental-health issues.[34] We’re constantly told that our lives are full of worry – about money, work, family and relationships. These very real issues can make the most relaxed person feel anxious. GAD means you might worry frantically about these issues – as well as a whole host of other ones which seem to tack on to the initial one. I can easily spend hours worrying about money, which seems like a rational focus, but my mind will immediately take me to a place where I’m stranded, bankrupt and chased by debtors. On top of that, I’ll suddenly feel besieged by anxiety about illness, about whether I might have offended someone at work, about whether I remembered to blow out a forgotten candle, or maybe I’ll start thinking I’m getting a serious illness. One worry ushers in another, and another, until your mind is swarming with them and you feel almost despairing. It’s a tangled web that happens in warp speed – you don’t know where to begin trying to tackle the mess.
David suffers with GAD, having lived with anxiety for as long as he can remember. ‘When it’s at its worst, it manifests itself in both physical and emotional ways. Physically, I always feel tense, have sweaty palms, am quite restless and unable to concentrate for long periods. If something is on my mind I get full-blown stomach aches, palpitations, sweating. Mentally and emotionally it manifests itself in constant worrying, racing thoughts – the inability to rationalise things or live with uncertainty. For instance, if I am unsure of how a meeting at work might go, I will obsess about it all day, and be unable to focus on anything else until it is resolved. I have phobias of certain things – flying, food poisoning/general health problems. It’s exhausting all round, really.’
Exhausting, because your whole body is trying to expend excess adrenaline. The adrenaline that comes with GAD is extraordinary. My default position is lying down in bed, snoozing away. But at my most anxious, I have the energy of a young gazelle. I could do star jumps for hours if I wasn’t so busy feeling like shit and biting off the skin around my nails while I tap my feet and fail to concentrate on anything for more than thirty seconds. It comes in like a violent wave to the shore, knocking over anything in its wake, and shocking you with its force. You wake up to it rushing into your belly, pushing up into your throat, telling you that danger is near. Adrenaline – great in a real crisis, terrible when there’s nothing to worry about. It feels way too real to be ignored, so you don’t. Something must be wrong. In a real crisis, adrenaline (and its ugly sisters norepinephrine and cortisol) might help you pull a child from a burning building with Herculean effort. With anxiety, you just feel physically ill – a sweaty, shaky, nauseous bundle of nerves. This contributes to a feedback loop – you feel physically full of fear; and this adrenaline might cause a panic attack. After that has subsided, you look for reasons as to why it happened – leading to ruminations and obsessive thoughts searching for a legitimate cause. You spend a lot of time fearing another episode of panic and that leads to extra adrenaline … and on and on.
The other symptom of GAD that I always find overpowering is the feeling of impending DOOM it can bring. I remember visiting a local supermarket with my mother several years ago, when I suddenly felt as though the world was about to end. The colours in the shop felt all wrong, and everyone around me looked sinister and unfriendly. I could feel my emotions plummeting, as though a dementor from Harry Potter had sucked all of the joy out of my body. From nowhere, I felt utter dread, as all the while people were just buying their dinner. The doom sensation is incredibly scary – you feel like there must be a reason for it – just as with adrenaline rushes, it’s hard to shake it off and chalk it up to anxiety when every part of you is telling you that danger is approaching.
This feeling of doom is not unique to me or my fellow sufferers in the twenty-first century. In 1773, London physician George Cheyne wrote The English Malady, a book in which he addressed his own anxiety, describing his ‘fright, dread and terror’.[35] He might not have experienced it in his local Sainsbury’s, but the feelings are the same.
I’ve described some of the anxiety illnesses most commonly seen. But maybe you don’t get the doom, or the panic attacks, or the weird eye-twitching. That doesn’t mean you don’t have anxiety, or that your experience is abnormal. I could write a book on all the various symptoms alone, or a PhD which would entirely consist of the mad thoughts and neuroses that I’ve had in my life. Nobody would read it though, probably not even me. I say this to reassure you that even if none of this sounds like you, it doesn’t mean that your anxiety is less awful or somehow not as life-affecting as anybody else’s. Mental health is not a Top Trumps game (this probably dates me horribly), and if anxiety has given me anything positive, it’s taught me to be more empathetic with others who struggle in life. We all have bad brain stuff. Don’t minimise your stuff, or compare it with other people’s. Having a loving family or a good job doesn’t mean you have to stay quiet when you’re struggling with mental-health problems – however small you think they are. You know better than anyone else whether something in your brain feels wrong – and if it does, seek help. Anxiety disorders usually get worse without intervention – whatever that ends up meaning for you. The things that have worked for me have been therapy, drugs and running. Your version of help might be different, but do make a serious effort to seek it out. It’ll be the best thing you can ever do for yourself, and for those who love you.
Anxiety is nothing new. Ancient Latin and Greek literature repeatedly references fear and worry. In the seventeenth century, the Oxford scholar Robert Burton described anxiety in his book The Anatomy of Melancholy, in which he wrote ‘what cannot be cured, must be endured’[36] – a pretty good saying even now. Panic attacks were referred to as ‘panophobias’ in the eighteenth century, and we’ve all heard the phrase ‘attacks of the vapours’. In 1869, American doctor George Miller Beard described neurasthenia – meaning nervous weakness – as a condition that the middle class was increasingly suffering from.[37] He believed that they were overcome by the rapid advance of modern society. Come talk to me about rapid advance now, Beard: just