When You are Okay with Not Being Okay: Thoughts on Generalized Anxiety Disorder

This week I filled out the GAD-7 and asked for more meds. With my chronic mental illness, I always struggle with feeling defeat, like the anxiety is winning and I am not doing something right when I need more or higher meds. Then I realize that’s the anxiety talking. It is the internalized stigma and messages from our culture talking. Why couldn’t I just do more self-care? Why can’t I just breathe more or meditate more? Why couldn’t I just access those imaginary bootstraps and pull myself up? Why can’t I just handle it or change my life in a way that will stop it? Why can’t I just calm down and relax?

BECAUSE I HAVE A FUCKING ANXIETY DISORDER.

It’s no defeat to get medication for an illness that manifests viscerally through your nervous system and impacts your thoughts and behaviors. As I have written about before, I have Generalized Anxiety. I always have. I don’t know, I like to hope not, but I will probably always have it. I could have 5million dollars and live on a beachfront with cabana girls bringing me unlimited nachos and foot rubs and I would still never hit zeros on that GAD-7. I mean, maybe the cabana girls don’t like my feet, maybe the nachos are tainted, maybe a tsunami will wipe us all out? Even if I distract away from the thoughts there is the never ending surge of adrenaline and norepinephrine that tells my body it’s being attacked by a tiger. Make that two tigers. And a bear.

The experience and treatment of anxiety is highly personal and ebbs and flows with time and context. I have tried every holistic method on the planet in my life for my nervous system. Tens of thousands of dollars have now gone into its treatment. Sadly, health is a privilege in this culture. I have seen energy healers, psychics and done all manner of pressure points. Diets of all kinds, gut treatments, homeopathy, supplements, herbs, you name it. 25 years of therapy and all kinds of modalities. I have massive skills for self-soothing. I have meditated for over 15 goddamn years. I am a fucking therapist and anxiety specialist, I teach this shit and have read more books than anyone I personally know on the topic. If someone could just naturally out-skill and out-lifestyle anxiety and make it stop, it would be me. I’m here to tell you I can’t and that is OKAY.

Mental illness always has a bunch of cultural shit that goes with it. I come from the Midwest in cowboy country where feelings are a sign of weakness. Fear and feelings are something to overcome and not to be talked about. I’ve spent a lot of clock hours in therapy unwinding this one. The good news is that the judgement is pretty straight forward in many ways, “your feelings aren’t okay, get over it.” A blunt and direct message is sometimes easier to work with than more subtle ones.

The holistic communities have judgment that is harder to unwind. There is a certain amount of shame and blame the victim that sometimes is an undercurrent of alternative medicine. Like if you just meditated more and eat this one specific diet with these particular herbs, your pain will go away. Or the source of your anxiety is your thinking and beliefs alone. There is commentary on how much you work or how you work. You just need to change everything and your suffering will be over. The hard part is that yes, to an extent these things are factors and I address them all the time in therapy personally and professionally. Certainly lifestyle choices impact health greatly. Skills and supplements help.

Also though: fuck you. This is basically saying “you and your choices create all your suffering and if you just changed all that you would be better.” One, Change increases anxiety up front. Two, if someone says they are guaranteeing results for health care, run. Three, blaming someone who is in pain for all their pain lacks compassion and promotes the belief that we can control our experiences. You can’t. You can have choice in how you respond, you rarely get control on what happens.

Look it, anxious people do a fine job themselves going over all the lists of what we do wrong or not well, of how we could be better and how we create our own suffering. Most of us work our asses off just to feel a semblance of peace and calm, to combat shame with compassion. I’ve done completely clean living and then binged on fucking pizza and frankly I have anxiety either way. Maybe to lesser degrees eating kale, but it didn’t just go away. Again, even if I lived on the beach with those fabulous cabana girls my nervous system would be alert and activated to a certain extent. Lord knows I’ve tried.

That’s because part, and sometimes a very large part, of anxiety and many mental illness is BIOLOGICAL. You might tell someone with diabetes to eat less sugar and exercise more, but you wouldn’t shame them for needing insulin. You wouldn’t say, “why don’t you just take a break and relax from your pancreas for a weekend.” While often well intentioned, unsolicited advice can be hurtful.

Sometimes I want to scream, “Motherfuckers if I could relax or take a break from this I would!!” My self-care has been a part to full time job for over a decade and it’s irritating as fuck when people start giving suggestions on what I could do to shift it. I know it’s well intentioned and meant to be helpful or connect, but it’s triggering. Would you ask the diabetic, “have you tried shifting your diet?” Ummmmm….you think? As I suggested in my depression post just give empathy and ASK if someone wants your input first.

Apart from all that stigma and well intentioned interpersonal angst, what I really want to talk about is acceptance. As I was requesting upping my Zoloft dose, the doctor said an interesting thing, “We can get you back to 0s.” I laughed and said, “Oh, I have no expectation of a 0. I haven’t had a zero in my life on an anxiety scale and I’m okay with that.” I like my doctor, she’s young and funny and edgy. She said, “Good for you! If you are okay with it then it’s not a problem.” Exactly. The problem often is unrealistic expectations or striving for some kind of normal that is not YOUR normal. While medical books and society paint this ideal portrait of what normal health looks like, I find there is no real norm. There is only your norm.

My normal for reasons biological, historical, psychological, and contextual is a little (let’s be honest, a lot) high strung and neurotic. My brain goes super-fast, my nervous system is very sensitive. I am hyper alive and alert. I’ve got a lot going on inside all the time mentally and physically. I don’t begrudge myself this. After years of therapy and deep reflection, I don’t actually want to be like other people who never think about all the various ways to die by a paper cut or the many kinds of bacteria that can cause food poisoning. I can’t relate to not analyzing the fuck out of every life experience. While sometimes it’s excruciatingly annoying in my own head, it’s also highly entertaining for me.

Those same mechanisms are why I can write with insight, make art, have intimate conversations with lots of different kinds of folks, have amazing empathy and is thankfully why I’m funny as fuck at times. It’s why when I travel I always have absolutely everything needed and enough for everyone. When I went to the Galapagos, the first night on the boat was rough. Big waves, high wind. Everyone was seasick. Everyone but me. I had enough ginger tea, Dramamine, and Bonine for everyone who needed it and then some. Sarah was amazed at how handy I was and proclaimed me the safest person to travel with ever. Like a good boy scout, I am always prepared. Thanks anxiety!

Look, everyone has anxiety at times and can relate a little. It’s our brains mechanism to protect ourselves, to prepare for things and even to learn. Think of a time you felt anxious about a job or test. Think of a time where you were worried for an ailing loved one, or irritable about someone perpetually annoying you. Now, think if those feelings were a baseline half or more of the time. Imagine that was nearly your constant state of being for no apparent reason. Your body feels like it did in those times of stress and your mind is going round and round about it, randomly finding reasons why you feel freaked out or fixating on things you know don’t warrant such a big reaction. Little things send you over an edge into total internal chaos. You either shut down or freak out or alternate between the two. Try to visualize how that would feel and that your usual coping strategies like distraction, exercise, talking to someone, using logic to stop it, or breathing….none of them shift it easily. You feel kinda trapped in it, out of control. The thoughts and feelings build on one another. It’s not rational and you can’t seem to stop. That’s Generalized Anxiety. It takes extra mental, emotional and physical supports and strength to function and thrive.

So instead of thinking of people with mental illness as weak we need to realize how fucking badass they are. When I am functioning and going about my day, I have a shit ton more grit and skills than someone not dealing with chronic anxiety. It’s like running a marathon where more neurotypical folks are jogging away carefree with bouncy shoes and a cool fanny pack and I am next to them disheveled and panting with fifty pound sand bags strapped to my head and shoulders. Sometimes I smile and leave them in the dust despite it. Sometimes I collapse and cry because “damn this shit is hard, fuck this race!” Then I inevitably get up again with one foot in front of the other. Dude, that’s strength. Folks, most of my life I wake up, get out of bed and pee first thing in the morning with those bags on my shoulders. I adapt and adjust and do all I can to let streams of sand and weight go if I can, to bolster, to have better posture, to rest. Sometimes I have to just stop for a bit. But never in my life has there not been added weight to my human experience to cope with. That is also why I have abnormal capacity to be with others stress. I’m not scared of emotional pain people, it’s the air I breathe.

I’m not writing this for a pity party or sympathy. I’m not even writing it to talk about me per say. Folks uncomfortable with vulnerability and honesty often mistake it for a cry for help or attention. I’ve got this folks, and I know how to resource when I need it, like asking for more meds. I am writing this for the reported quarter of the diagnosed American population living with an anxiety disorder. I’m writing this because I have listened to over a thousand people by now talk about GAD. While my story is unique to me, my symptoms and experience are not so different from many others. YOU KNOW PEOPLE CARRYING THOSE BAGS RIGHT NOW. Maybe some people need you to ask if they need help to carry the load. Some act strong and want you to check on them and ask if they need anything. Maybe some, like me, really need empathy and understanding for how heavy it is. Maybe a shout out for a job well done helps from time to time. “Hey! Great job adulting despite the huge sacks of sand you are carrying! You rock!” The validation helps balance the sense of aloneness and exhaustion that comes with trying to run the same race as you. Some people just need a whole different marathon route, they need greater accommodations for their metaphorical life race. Some people need resources for medication, therapy, or support. Maybe some of the other ¾ of people in the US are carrying the bags of GAD and don’t even know it. What people don’t need is more stigma or ignorance. Or people trying to force a cultural or personal norm onto them that they too can somehow reach the ideal “living my best life” Instagram shot or pharmaceutical commercial plot of running happily through a park with puppies, bubbles and rainbows. And some people do recover fully from anxiety and get those puppies and rainbows, I am thrilled when that happens. I’ve seen it happen. I’ve just never been one of them and that’s OKAY.

My anxiety is not something to fix. I am not someone to fix. It is something that I cope with, it’s a part of how I have developed and experience the world. Anxiety is something I adapt to, a struggle I am in deep relationship with and create meaning and growth from. That’s OKAY with me. It’s OKAY with me when I’m not okay, when I fall down from the weight and need to rest. That’s part of my biology and make up. I don’t like it, but I also don’t need to pretend that’s not gonna happen from time to time. I fall, I get up. Repeat. Badass. What we do need for ourselves and others is more acceptance, and maybe even embracing the wisdoms and strengths of anxiety. Fighting anxiety ironically creates more anxiety with some expectation of the elusive constant calm. The ambiguous societal normal is toxic. The expectation of never falling or carrying no bags use to kick my ass. Every time I fell down was a big trauma. “Why me?!?! When will it stop forever?!?!” Insert existential scream here. Now it’s more, “that sucks, let’s regroup, what do I need now, it will shift at some point.” Insert existential sigh here, trust impermenance. In other words, I have found that the more I just accept the fact that I have an illness I constantly attend to, the easier it is to schlep those bags and fly. Sometimes I even fall less or more gracefully. May you find your way in it, or a way to support others that works for them.

May we all sail in peace.