The Anatomy of Anxiety

Understanding and Overcoming the Body's Fear Response

Ellen Vora

• Publisher: Harper
• Year: 2022
• ISBN:
  9780063075115
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

From acclaimed psychiatrist Dr. Ellen Vora comes a groundbreaking understanding of how anxiety manifests in the body and mind—and what we can do to overcome it.

Anxiety affects more than forty million Americans—a number that continues to climb in the wake of the COVID-19 pandemic. While conventional medicine tends to view anxiety as a "neck-up" problem—that is, one of brain chemistry and psychology—the truth is that the origins of anxiety are rooted in the body.

In The Anatomy of Anxiety, holistic psychiatrist Dr. Ellen Vora offers nothing less than a paradigm shift in our understanding of anxiety and mental health, suggesting that anxiety is not simply a brain disorder but a whole-body condition. In her clinical work, Dr. Vora has found time and again that the symptoms of anxiety can often be traced to imbalances in the body. The emotional and physical discomfort we experience—sleeplessness, brain fog, stomach pain, jitters—is a result of the body's stress response. This physiological state can be triggered by challenging experiences as well as seemingly innocuous factors, such as diet and use of technology.

The good news is that this body-based anxiety, or, as Dr. Vora terms it, "false anxiety, " is easily treated. Once the body's needs are addressed, Dr. Vora reframes any remaining symptoms not as a disorder but rather as an urgent plea from within. This "true anxiety" is a signal that something else is out of balance—in our lives, in our relationships, in the world. True anxiety serves as our inner compass, helping us recalibrate when we're feeling lost.

Practical, informative, and deeply hopeful, The Anatomy of Anxiety is the first book to fully explain the origins of anxiety and offer a detailed road map for healing and growth.

Part I

It’s Not All in Your Head

Chapter 1

The Age of Anxiety

Problems that remain persistently insoluble should always be suspected as questions asked in the wrong way.

—Alan Watts, The Book: On the Taboo against Knowing Who You Are

We are in an unprecedented global crisis when it comes to mental health. An estimated one out of every nine people, or eight hundred million people, suffer from a mental health disorder, the most common of which is anxiety. Indeed, almost three hundred million people worldwide struggle with an anxiety disorder.¹ And the United States is one of the most anxious countries of all: up to 33.7 percent of Americans are affected by an anxiety disorder in their lifetime.² In fact, from 2008 to 2018, incidences of anxiety in the United States increased by 30 percent, including an incredible 84 percent jump among eighteen-to-twenty-five-year-olds.³ Not to mention that the recent COVID-19 pandemic served to steeply escalate already dire circumstances. The number of people reporting symptoms of anxiety and depression skyrocketed by an extraordinary 270 percent, as researchers at the Kaiser Family Foundation found when comparing 2019 to 2021.⁴

And yet, while these statistics paint a grim picture, they also offer a reason to feel hopeful. These rates would not have risen so precipitously if these disorders had a predominantly genetic basis—which was our presiding understanding over the last several decades. Our genes cannot adapt so quickly as to account for our recent catapult into anxiety. It stands to reason then that we are increasingly anxious because of the new pressures and exposures of modern life—such as chronic stress, inflammation, and social isolation. So, odd as it may sound, this recent acceleration is actually good news because it means there are straightforward changes that we can make—from a shift in diet and sleep routines all the way down to better managing our relationship with our phones—in order to have a powerful impact on our collective mood. By widening the lens of our understanding to encompass not only the aspects of anxiety that occur in the brain but also those that originate in the body, we can more effectively address our current, and vast, mental health epidemic.

WHAT DO WE MEAN BY “ANXIETY”?

Anxiety has been recognized as far back as 45 BC, when the Roman philosopher Marcus Tullius Cicero wrote in the Tusculan Disputations, as translated from the Latin, “Affliction, worry and anxiety are called disorders, on account of the analogy between a troubled mind and a diseased body.”⁵ It is interesting that he would mention the body, given that anxiety has since then wended its way through history primarily understood as a problem of the mind; it is only now, twenty centuries later, that we are returning to the notion that the body plays a critical role in determining our mental health. The word anxiety derives from the Latin word angor and its verb ango, meaning “to constrict”; in fact, in the Bible, Job describes his anxiety correspondingly as “the narrowness of my spirit.” As time wore on, the term anxiety became more closely affiliated with a sense of impending doom, or as Joseph Lévy-Valensi, a French historian of psychiatry, described it, “a dark and distressing feeling of expectation.”⁶ This definition remained largely unchanged throughout modern history, though it became increasingly clinical in its description once the disorder was introduced in the DSM-1, the Diagnostic and Statistical Manual of Mental Disorders, published in 1952. In the DSM-5, its most recent incarnation, anxiety is familiarly defined as “the anticipation of future threat,” but the disorder is also broken up into an array of classifications, such as generalized anxiety disorder, social anxiety, panic disorder, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD).⁷ Modern conventional psychiatry uses this multiplicity of classifications to steer treatment.

In my practice, however, I don’t use such specific designations in naming my patients’ anxieties. Though some believe that “anxiety” has become diluted or too all-embracing—indicating almost any feeling of discomfort—I think that the term cannot be too broadly used. If you’re asking the question Do I have clinical anxiety?, I believe you are suffering in a meaningful way. I want you to trust your subjective experience of uneasiness more than I want you to worry about whether or not you qualify for a diagnosis. Over the years, I have seen anxiety expressed in such a myriad of ways among my patients that I have come to accept that it can be experienced as a vast and ever-shifting array of symptoms. I have patients who tell me that their lives feel generally fine—they are happy and healthy and have dynamic and supportive relationships—but they become paralyzed when under pressure at work. For them, anxiety—whether asserting itself as “impostor syndrome” or an inability to stop the mind from spinning in too many directions at once—serves as a barrier to dropping in and concentrating. I work with others who have anxiety solely around social life; some who never feel relaxed, constantly nagged as they are by some sort of dread or rumination; others who experience panic attacks out of the blue; and still others who feel only physical sensations—dizziness, light-headedness, or tightness in their chests or tension in their muscles. All these feelings are valid expressions of anxiety.

But there is also another critical reason I don’t emphasize diagnosis in the work that I do. I have found that giving a diagnostic label—though it can offer immediate relief as a succinct interpretation of a fairly messy circumstance—can soon become a straitjacket of sorts, narrowly defining people and profoundly shaping their life narratives. Patients sometimes begin to conform their stories toward a diagnosis, making themselves smaller as opposed to opening to the more expansive lives they could be leading. So, ultimately, I’m less concerned with whether a person has panic disorder with agoraphobia or OCD or generalized anxiety disorder and more interested in exploring the particulars of each patient’s life and habits in order to start them down a path to recovery.

TRUE/FALSE ANXIETY

And yet there is a distinction that I make within the realm of anxiety to help clarify what is being communicated to you by your body—and that is of false and true anxiety. This is not a diagnosis but rather an interpretation that I have found has helped my patients target the source of their unease and more swiftly identify the steps that need to be taken toward greater comfort and happiness. Julia Ross, a pioneer in nutritional therapy, first opened my eyes to this concept in her book The Mood Cure. Ross proposes that we have true emotions and false moods. True emotions occur when something steeply challenging has happened: a family member passes away, and you’re grieving; you lose your job, and you’re stressed; you’re going through a breakup, and you’re sad. These “genuine responses to the real difficulties we encounter in life can be hard to take,” writes Ross, “but they can also be vitally important.”⁸ A false mood, on the other hand, is more like an “emotional impostor,” as Ross puts it, when we seem to just wake up on the wrong side of the bed or, seemingly out of nowhere, find ourselves feeling irritable, sad, angry, or anxious about things that wouldn’t normally trip us up. At these times, our minds are all too happy to swoop in with an explanation. Our brain says, Maybe I’m anxious because my boss’s aloof email seems to suggest I’m underperforming at work; or Something about that text from an old friend is not sitting right with me. Our minds are meaning makers. Give us a picture of two dots and a line, and our minds see a face; give us a hangover and a cold brew in lieu of breakfast and we think we’re in trouble at work, our relationship is falling apart, or the world is doomed, because our minds like to tell us stories that explain our physical sensations. And much of our worry is just this: our minds trying to justify a stress response in the physical body.

Ross’s paradigm can also be applied exclusively to anxiety. False anxiety is the body communicating that there is a physiological imbalance, usually through a stress response, whereas true anxiety is the body communicating an essential message about our lives. In false anxiety, the stress response transmits signals up to our brain telling us, Something is not right. And our brain, in turn, offers a narrative for why we feel uneasy. It tells us we’re anxious because of our work or our health or the state of the world. But the truth is, there is always something to feel uneasy about. And the reason we’re struck with anxiety in this moment actually has nothing to do with the office and everything to do with a state of physiological imbalance in the body—something as simple as a blood sugar crash or a bout of gut inflammation. Much of our anxiety, in this sense, is unrelated to what we think it’s about.

But let me make a critical clarification: just because I refer to these sensations as false anxiety does not mean the pain or suffering is any less real. Even if a mood is the direct result of a physiological stress response, it can still hurt like hell. This term is not meant to invalidate the experience of these moods. The reason I feel it’s important to identify these states as false is that it allows us to see a clear and immediate path out. This type of anxiety is not here to tell you something meaningful about your deeper self; rather, it’s offering a more fundamental message about your body. And when we recognize that we are experiencing anxiety precipitated by a physiological stress response, we can address the problem at the level of the body, by altering our diet or getting more sunshine or sleep. In other words, false anxiety is common, it causes immense suffering, and it’s mostly avoidable.

Once we are able to target and eliminate this physiological source of our distress, we can then more directly address the deeper anxiety—our true anxiety—that arises from having strayed from a vital sense of purpose and meaning. At base, this anxiety is what it means to be human—to know the inherent vulnerability of walking this earth, that we can lose the people we love and that we, too, will one day die. Or as the nineteenth-century Danish existentialist philosopher Søren Kierkegaard described it, “the dizziness of freedom.” This anxiety also, in some ways, keeps us safe. We are all here, after all, because our ancestors were vigilant enough to survive; this anxiety can fuel us to protect ourselves and to keep our lives in motion. But it also often arrives with a message—with intuition and wisdom from deep within—about what we need to do to bring our lives into more alignment with our particular abilities and purposes; it is essentially a guide for how to make our lives as full as they can be.

Chapter 2

Avoidable Anxiety

It isn’t disrespectful to the complexity of existence to suggest that despair is, at times, just low blood sugar and exhaustion.

—Alain de Botton

When we are anxious, it can feel like everything is conspiring to overwhelm us: our relationships confound us, work presses and prods us, the world feels like it’s barreling toward certain disaster. But many of the dreadful feelings and terrifying thoughts we call anxiety are simply the brain’s interpretation of a fairly straightforward physiological process that comprises the stress response. And yet, in traditional psychiatry, doctors are trained to treat mental health problems by addressing solely the mind, with medications to alter brain chemistry and therapies to target thoughts and behaviors. As a result, most psychiatrists have implicitly learned not to overstep their bounds and get involved with matters of the physical body. I believe, however, that this approach has held the field back, limiting psychiatrists’ treatment options when there is such an extensive range of ways to treat the mind through the body.

With the rise of integrative and functional medicine—and the newly burgeoning field of holistic psychiatry—we have begun to understand mental health disorders anew. Indeed, the evidence, not to mention the demand by patients, to take a more holistic approach to mental health has been mounting. For instance, a 2017 study known as the SMILES trial (an acronym for Supporting the Modification of lifestyle in Lowered Emotional States), led by Felice Jacka, an associate professor of nutrition and epidemiological psychiatry at Deakin University in Australia, looked at the impact of improving nutrition compared with social support in people with moderate to severe depression, all of whom ate diets of primarily processed foods; ultimately the researchers found that 32 percent of those receiving dietary support achieved remission compared with 8 percent in the social support group.¹ Similarly, in a number of different studies, the spice turmeric—used for centuries in Ayurvedic medicine, the ancient healing practices of the Indian subcontinent—was shown to have the ability to decrease inflammation and thereby modulate neurotransmitter concentrations involved in the pathophysiology of depression and anxiety.² (Inflammation occurs when the immune system is mobilized to address a threat, such as injury or infection, and it can directly signal that the body needs to fight back, leaving us feeling anxious.) So, while brain chemistry and thought patterns do play a role in anxiety, I would argue that these are often “downstream” effects—meaning that much of the time our brain chemistry changes as a result of an imbalance in the body. In other words, the root cause of false anxiety begins in the body, and it should be treated there as well.

THE SCIENCE OF FALSE ANXIETY

The general understanding in conventional psychiatry is that anxiety is largely the result of a genetic chemical imbalance in the brain. But there isn’t consensus on the mechanisms causing anxiety, aside from the consistent focus on the neurotransmitter serotonin. However, there is another neurotransmitter, GABA (gamma-aminobutyric acid), that serves as the primary inhibitory chemical messenger of the central nervous system—and this, too, plays a critical role in assuaging our nerves. In my opinion, GABA hardly gets the attention it deserves, at least in our public discourse, given what a critical natural resource it is for battling anxiety. The effect of this neurotransmitter is to create a sense of calm and ease and, therefore, it has the power to inhibit an anxiety spiral. So, when we start dreaming up all the terrible worst-case scenarios that could occur in our lives, GABA can whisper to us, Shhh, no need to worry, that’s not likely; everything will be fine. Conventional psychiatry, as a result, often deduces that a person experiencing anxiety has poor serotonin or GABA signaling and, ultimately, is not getting enough of the reassurances these neurotransmitters have to offer. It is my belief, however, that false anxiety is less about genetic destiny and more about the circumsta...

Table of contents

• Cover
• Title Page
• Dedication
• Contents
• Introduction
• Part I: It’s Not All in Your Head
• Part II: False Anxiety
• Part III: True Anxiety
• Acknowledgments
• Appendix: Herbs and Supplements for Anxiety
• Notes
• Index
• About the Author
• Copyright
• About the Publisher