There has been a lot of interest in the problems of anxiety in the media recently.
About a month ago, Scott Stossel – editor of the high profile Atlantic Magazine – appeared on the Kim Hill Saturday morning radio show here in New Zealand having written a very moving account of his lifelong battle with crippling anxiety. Scott is a very successful editor and well known personality, so it came as a shock to many people that he had suffered so long (and seemingly managed) with this condition. (You can hear the full interview with Kim Hill here).
More recently, Australian writer, singer and broadcaster Sian Prior spoke candidly about her own battle with anxiety.
A few days ago, the Huffington Post and the New York Times both ran extended collections of essays on the problem of anxiety today. There has even been an anxiety film festival announced, to highlight how often anxiety features in the movies (think here about how ‘thrillers’ are supposed to make you feel).
In a fantastic counterpoint to some of the bleaker perspectives offered by the mainstream media, Katie Roiphe has written in the Financial Times Magazine about the ‘Joy of Stress‘ and the joys of being ever-so-slightly ‘wired’. After all, she says, isn’t ‘there something vaguely bovine, dull, about the state of being unstressed? Is there something slow, unfruitful, stagnant or dense about calm? You, with your fruity cocktail under the palm trees, are you boring?’
I’m interested in this upswing in interest in anxiety for a number of reasons:
- As a physiotherapist who has worked with anxious patients and as a university lecturer teaching breathing therapies for panic/anxiety
- As an historian who has studies neurasthenia – a condition not unlike chronic anxiety – that was one of the most prevalent disorders of Western society in the 19th century
- And as someone who has experienced their fair share of anxiety
My own experience
Taking these in reverse order, I’m sure that my interest in the management of anxiety (I don’t think that ‘treatment’ is the right word to use here), stems from my own experiences of panic/anxiety. I can think of at least three occasions as an adult when I’ve experienced acute anxiety: once at a bar with a friend after many months of family stress; once while swimming in open water; and, more recently, doing a presentation to my colleagues.
As I’ve come to understand the things that trigger stress I’ve learnt to manage it better, but it’s still a struggle to know what is ‘good’ stress and what is ‘bad’. I strongly believe that most lecturers feel a degree of anxiety whenever they ‘perform’ in front of others and that their seeming comfort stems from a bravado that gives them enough confidence to get over their anxieties. I know that most of my colleagues would be surprised to know that I was often anxious, but that’s part of the whole experience. One’s ability to conceal the tumult going on under the surface is what we all do isn’t it.
Neurasthenia as an early form of anxiety
Most of my academic career has focused on developing critical histories of physiotherapy and the physical therapies (massage, mobilisations and manipulations, therapeutic exercise and remedial gymnastics, hydrotherapy and electrotherapy). There is very little written about the history of physiotherapy – something I’m hoping to tackle in the coming years.
One of the things that is not at all well understood is how the early founders of physiotherapy (in England at least) used neurasthenic women as a vehicle to legitimise physiotherapy in its early years. (I’ve written a little about this here: Nicholls, D.A. & Cheek, J. (2006). Physiotherapy and the shadow of prostitution: The Society of Trained Masseuses and the massage scandals of 1894. Social Science and Medicine 62: 2366-2348 [follow link to access via PubMed]).
Neurasthenia bore a striking resemblance to the breathing pattern/hyperventilation problems that are so much of an interest to health practitioners today. Originally developed in America in the second half of the 19th century, neurasthenia was similar to hysteria and concerned people’s reserves of ‘nerve force’.
Some people (often working age, educated, middle- and upper-class women) were supposedly especially prone. It was felt that these women were not cut out for rapidly advancing Western world, with its telegraphs, railways and electric lighting. Corsetry no doubt caused major physiological disruption but it was Silas Weir Mitchell’s infamous Rest Cure that courted the most controversy. Women were removed from home and put into isolation for 6 – 8 weeks, during which time they were force-fed and treated as infants – being entirely passive, even having their teeth brushed for them. The cure was designed to ‘fatten them up’ but not wanting the women to waste away, doctors prescribed a rigorous routine of daily passive exercises, including massage, passive movements and electricity. While it was nurses that stayed with the woman for the duration of the cure, it was masseuses who came in to do the treatment. (Marijke Gijswijt-Hofstra’s 2004 book ‘Cultures of Neurasthenia‘ probably provides the best introduction to this subject). This is an important, yet almost entirely ignored chapter in the history of physiotherapy, and one that deserves more scholarly attention.
My physiotherapy work
Finally, I’ve combined my own personal experience and historical interest in my physiotherapy work. I teach a postgraduate paper at AUT University in Auckland, New Zealand titled ‘Breathing, Performance and Rehabilitation’, and previously worked for five years with one of New Zealand’s most innovative clinics ‘Breathing Works‘. I’ve learnt from this work that for a lot of people, simply knowing that they have a breathing problem answers a lot of questions. People who have had ongoing pain, dizziness, blurry vision, feeling spaced-out, struggling to take a satisfying deep breath or thinking that they’re breathing too shallowly, poor concentration, digestive problem, etc., etc., have been helped immeasurably by recognising that by changing their breathing, they can shake of some or all of their symptoms.
I use a simple assessment tool with my students called a Nijmegen Questionnaire (link) to begin looking at people’s breathing. The questionnaire is far from perfect, but it has proven a useful tool to identify breathing problems. People should ideally score zero, but people who score in the 20s are really having problems and breathing retraining can often help them.
I would like to be able to say that my own anxiety has gone away, but the truth is I think that there’s part of me that values it. I like to think of myself as someone with a lust for life and a passion for doing things that are challenging and interesting. I recognise more than I used to that sometimes my excitement gets the better of me, or that I’ve been pushed to do some of the things that I know are anxiety provoking. Fortunately (and as is often the way with anxiety) it has rarely overwhelmed me, and I’ve gained a lot from my joie de vivre. Most importantly though, I’ve learnt not to let it make me ill, and for that, I’m grateful.