Ask Dan’s Mom, Pt. 2

Every Friday I ask my mother, Marilyn Smith — psychotherapist, anxiety expert, and genetic wellspring of my neuroses — some questions about anxiety, anxiety disorders, and anxiety treatments.

The series “Ask Dan’s Mom” will continue as a one-on-one correspondence for a little while — until my mother and I exhaust the conversation or she gets pissed at me, whichever comes first. At that point, I’ll open the floor to questions from readers, thus turning the series into a new breed of advice column: Dear Abby for Neurotics. If you have a question about anxiety you’d like me to share with my mother, please email me at dansmonkeymind@gmail.com.

Part 1 of “Ask Dan’s Mom” here.

Good morning, Mom. In last week’s exchange, you mentioned that a tendency toward anxiety may be caused by “the way you were brought up by your parents.” I know that you’ve had a hard week, what with Grandma being sick, so I’m going to let that one pass. For now, let’s talk about treatment. One thing that’s always confused me about anxiety is what exactly to do about it. There are so many treatment options, from medication to psychotherapy to meditation to acupuncture to I don’t know what else: sweat lodges? religious conversion? coffee enemas? What would you say to someone who perplexed by all these offerings?

Thanks for going easy on me this week, sweetheart — though now you’ve got me nervous about future installments!… To begin with, I know how scary it is to feel anxious and to have no clue about where to turn for help. Generally, I think the best idea is to first go to your doctor and let him or her check you out — this to make sure you don’t have any medical problem that may be making you feel jittery. If you’re OK (which you probably are) then I think the next step is to make an appointment with a therapist who specializes in anxiety. Most doctors can give you a referral. Or go to the Anxiety Disorder Association of America’s website; they maintain a list of well-trained clinicians. If you think you need medication then you can ask the therapist for the name of a psychiatrist. Meanwhile, I would definitely try exercise: brisk walking or jogging is just great. Meditation, yoga, or tai chi might help also. Whatever you do, though, it’s very important to be patient. It may take time to feel better, but you won’t always feel the way you do right now.

I’d like to quibble with you on that last part, Mom. You say, “You won’t always feel the way you do right now.” This is something you’ve always told me, and it’s a comforting sentiment. But I first started experiencing anxiety eighteen years ago and I still feel anxious. It’s not as bad, but it’s certainly still there. I still have to fight against it every day. Do you think it’s true of most people who have been diagnosed with an anxiety disorder that it won’t ever totally go away? Or am I just exceptionally jittery?

You may be exceptionally jittery; I’m not sure. But probably you’re just a little lazy…. Listen: I think it’s really important to offer hope and optimism here, as well as encouragement. The key is to “follow the program.” By that I mean exercising, eating less sugar, seeing the right shrink, engaging in some sort of meditational activity (which could be anything from dancing to boxing to knitting to formal meditation), and taking medication if warranted. If you do this then yes, you will probably have to continue working at it every day — but you don’t have to have this warlike attitude. You don’t have to think of your life as this great battle against anxiety. You can just think of yourself as leading a healthier lifestyle than the one you were leading before.

And this worked for you? Has “following the program” made your anxiety manageable or even functionally nonexistent?

Yes, for the most part it really has. You know that I’m something of a maniac when it comes to exercising. I take frequent brisk walks and do pilates and (sometimes) yoga. I hardly have caffeine anymore and I eat right. My anxiety still pops up when I’m faced with certain stressors and when I’m trying new things that scare me. But even that I now think of in a positive way. Eleanor Roosevelt said, “Do one thing that scares you every day.” I agree. I believe that it’s very important to constantly face your fears in order to get stronger and build confidence. It’s worked for me and it works for the patients I see who are constantly faced with fearful situations. As confidence increases, anxiety decreases! So yes, following a program of a healthier lifestyle, therapy and meds when needed, plus doing something “scary” everyday (like revealing yourself in your son’s blog!) has definitely helped me manage my anxiety, which is fairly well contained at this point in my life.

And what point is that? How old are you, exactly, Mom?

Shut up, you little punk.

17 Responses to Ask Dan’s Mom, Pt. 2

  1. Beverly Cohen says:

    Love your “tell it like it is” and positive responses! I can see why you are an exceptional therapist.

  2. Talie Smith says:

    This is really a great exchange, and I look forward to more. I am, as usual, enlightened and uplifted by both of your sentiments…especially Marilyn’s. You really do live the program and it shows!

  3. David Mebane says:

    Interesting blog. I’ve suffered from (sometimes crippling) anxiety all my life. I deal with it now mostly by reminding myself that I can deal with it: “you won’t always feel the way you do right now” is what keeps me from falling into the vicious cycle that is the fear of being afraid.

  4. Marguerite Iannone says:

    Way too much Xanax and Zoloft being prescribed. Life’s stressors come and go. Some worse than others. At the first sign that a person is too heavily stressed, the MD suggests drugs. I and my husband, at different time, have need these medications. However, it was my game plan to use on a temporary basis. In that plan I was successful. Ingested 50 mg Zoloft for about eight months and the drug did help to sort me out. When things were level, I began to come off. My husband has been ingesting 300 mg Zoloft for six or seven years. He retired due to mental “collapse”. Six years later he has far few stressors and has decided to come off. His Phsyc told him when he spoke of decreasing his dosage that, if he wanted to do that he could “try”. Offered him no plan, also. So we researched it on line and I asked my Doctor and all is going well right now. He is down to 100 m and hoping to rid his brain of it all together. By the way, the Xanax was thrown in if “a situation” developed that set your hear racing. The decreased Zoloft has caused some minor detox symptoms that are tolerable and do dissipate after enough time. The worst case is that he will have to stay on the Zoloft/Xanax but maybe we will be lucky and at least decrease the dosage or rid ourselves of this “medicinal assist.”

    My opinion is that there is entirely too much psych medication being prescribed without adequate follow by the medical community. It is far easier to hand a script to someone and keep those insurance reimbursements rolling in than worry about if a brain loaded with 300 m of Zoloft can now have a chance to try life without it. My doctors both internal med and psych were proactive along those lines of thought. However, I went in with my depressing/anxiety with that stipulation give. That I wanted to TRY for a short supervised time. My husband, on the other hand, sees a shmoe and is taking proactive action. If he fails, we are planning to see a new psych MD.

    To all out there – if you have been using psych meds and anxiety meds, try to experience life NOW. Stressors come and go. These meds can be a beautiful tool to move one along to a healthier place, but they have become part of your brain’s daily diet. Maybe, just maybe, your brain/mind is better able to cope – try it.

    Sincerely, Marguerite Iannone

  5. Therry Neilsen-Steinhardt says:

    I too have lived with anxiety all my life, and moreover, was crippled by my father’s anxiety as a child and young adult. He dealt with by pursuing physicians and every mood-altering drug that came along, not to mention stunning amounts of alcohol. I have dealt with it with moderate amounts of medication and lots and lots of exercise. I lift weights, which is very satisfying, and I do yoga, although it is very hard to still the inner critic in yoga. It’s important to find the exercise that your body is crying out for. The first time I picked up a five pound dumbbell I knew I had found my exercise. There is something about the need for form and the challenge of trying wights that are a little too heavy for you that engages me at a deep level. My favorite yoga pose is a plough, a dangerous one, mentioned in the NY Times’s magazine article last week.

    It’ss not cheap bourbon, but it works for me.

  6. At first I was glad to see an article about anxiety, but then I thought I’d be too scared to read about it. NOT!

    Until I was in my mid thirties I suffered from terrible anxiety- sweaty palms, ragged breathing- I was just plain scared of everything, so I consulted a psychoanalyst, who told me that I had the worse case of anxiety that she had ever seen in someone who was not in a hospital.

    I asked her for tranquilizers, and she said no.

    Many people take tranquilizers; I’ve never regretted that I never have. Here’s what helped me:
    1. psychoanalysis
    2. yoga- not standing on my head, necessarily, but using it by taking asana class, meditating regularly, and doing pranayama, (breath work), which calms you down by slowing the respiratory and heart rates.
    3. humour

    I’m sure that Daniel Smith’s future articles will explain the many ways people combat anxiety. I’m looking forward to reading more.

  7. jpcook says:

    Your mom is humorous and thus reassuring. Too much siriousness exacerbates anxiety. I was afflicted so badly in my mid thirties that I was scared to fall asleeo in case my autonomic nervous system forgot how to breathe. Is that nuts or what? And the funny thing was that i knew it was nuts at the time. I was totally exhausted which made it much worse. The closest thing to a cure for me (without drugs) has been vigorous exercise. One early evening way back then (I’m now 47), I decided to try a spin class. It was hard and my lungs ached afterwards, but it was the first time in months that I fell asleep the way you’re supposed to. Since then I’ve been doing martial arts and my anxiety is totally managed on a day to day basis. I really believe that expanding your lungs with air and flushing your brain with the rush of oxygen that comes from physical exertion is THE key element to managing this sometimes nonsensical affliction.

  8. For me, my anxiety is always rooted in fear. I recall that as a grade school student being terrified that the Soviets were ready to unleash their nukes at any moment. We even had drills in my grade school, scooting under our desks, in an absurd preperation for what the popular publications of the time, especially Life magazine, were reporting as inevitable. Total nuclear destruction and overpopulation were the twin terrors of my childhood and think taught me to think “anxiously.” It’s cliche, but for me ‘staying in the moment”, concentrating fully at the task at hand, be it as mundane as making breakfeast or as complex as beginning a new painting in a new style, has helped me to keep my anxiety of what might or could happen at bay. I think it was Hemingway who said that. “courage is the ability to suspend one’s imagination.” Although my work demands imagination, I now carefully choose to imagine only the things of whose outcome I have some control.

  9. Michael S says:

    Came across this while reading the Times article. Nice blog and very helpful. After reading the entries I wrote the following:

    Life doesn’t have to be a constant state of siege like a war inside the mind. We can exist with these thoughts as like water running through a creek. The water flows and hits rocks but it continues to flow wherever it might lead. In the same way our minds thinking should not be dammed up like mankind has done to natures rivers but allowed to flow where it will as it will go.

    I was/am/will always be(?) a sufferer of anxiety for a very long time and (finally) have a handle on the issue. I attend AA meetings, work with a personal trainer 3 days a week, and train under an amazing Sensei at a dojo that focuses on Kyokushinkai training.

    I no longer abuse substances, my anxiety requires occasional meds (clonazepam as needed – whereas used to take a lot (4mg) of Xanax a day and there are regular visits to a psychologist (twice a month) and psychiatrist (every couple of months).

    All of this costs a lot of money taking a great deal of time and effort. Believe me, when I say that if my troubles can be overcome then there is hope for all!!!!

  10. Mariel says:

    I was a sufferer of crippling anxiety and was lucky to fall in the hands of a wonderful therapist. First, she made me understand what was happening to my mind and body and was causing my anxiety. Then she taught me how breath again, as I was incapable of doing so. She also taught me how to do imagery and deep breathing while taking long brisk walks. In addition, as I was suffering from imsomnia, she showed me how to make myself sleep. Furthermore, she taught me how to deal with problems and/or stressors. All without medication. It has been 25 years since my last anxiety attack. I am forever thankful to this brilliant woman. And thank you Daniel for the Monkey Mind Chronicles!

  11. Jeff Heller says:

    I am sorry to say this but your mother, nice as she doubtless is, sounds like a (big ) part of your problem, in so far as she is, I would surmise, completely sold out to the self-serving nonsense perpetuated by the ‘psycho’ industry. My heart goes out to you, man, less so because of your anxiety as that you’re probably going to have to reject your mom’s baby boomer bullshit, if you’re ever to break free of 18 years of suffering.

    The fact is (as you and several responders suggested in your NYT piece) the problem is out there, not inside our individual ‘monkey minds,’ and if we are ever going to change things (in either sphere), I believe we are simply going first to have to reject all those experts and professionals who would ply you with potions and platitudes, whose aim is to keep you focused on your addict-like need for relief — which is to say ever dependent on them.

    Hey, I have an idea. You’re a good writer. Why don’t you drop the whole campaign to legitimate the myths of mental illness and psychotherapy (to quote Thomas Szaz) and join me in relieving folks of the added burden of blaming themselves for failing to find meaning (purpose, security) in this crazy competitive consumer culture of ours. Or you can go on fretting over which salad dressing to use. Up to you. . . .

    • Daniel Smith says:

      Hi, Jeff. Well, I can’t say I agree with you — either about my mother being a part of the problem or about the “psycho industry.” People have been seeking out chemical and psychological interventions for their nerves since way before the boomers were born — centuries before. So I find a certain pitiless nihilism in your response: forget all those suffering souls, let’s purge the culture! Of course there are problems “out there.” But those problems out there redound negatively on the individual mind, and the individual mind looks for succor. You may disagree with the mental-health industry, or rather with its towering influence — and I too have some problems with the level of its influence — but I wouldn’t go all the way with you in characterizing it all as nefarious bullshit.

      • Jeff Heller says:

        Hi Daniel,

        I used to regard psychoanalysis (which is after all an Enlightenment-style eneavor to ‘bring into the light of day’ much of the explorations into the dark side that a century of Romanticism had plunged the European and American minds) as a quite viable (i.e., depression- and anxiety-relieving), pragmatic, secular belief system. But as drive theory morphed into ‘ego psychology’ and then to the ‘object relations school’ which then collectively gave way, in succession, to behaviorism, ”humanistic psychotherapy,’ cognitive-behaviorism and ‘transpersonal therapy’ and most egregiously (IMO) to the explosion in the use of psychopharms, it has become abundantly clear to myself (as well as many other observers) that what you have is an industry which (as with certain politicians) will change course on a dime in order to keep pace with ever-evolving, ever-expanding social and cultural constructions.

        But of course, the main concern is and should always remain what can/should be done about those in need. Which is precisely why I believe it is vitally important to question and critique the pretensious presumptions and outright harm done by the obfuscating psy industry. Because in so doing we clear the way for people to: not blame themselves for their ‘inadequacies,’ which is tantamount to turning themselves over to the shrinks for ‘restructuring;’ and instead — perhaps as a result of the sort of soul-sharing that admirable plights such as your own tend to engender — to begin to look critically at the culture and (more significantly) the underlying political economy for the real causes of our shared distress — and consider what we as a society might want to do do about it.

  12. loonbird says:

    Excuse me, Daniel – but you are seeking your mother’s psychiatric advice online, and she won’t even divuluge her AGE? How coy is that?

    What will happen to your anxiety level when she dies?

    I hate to think….

  13. Jessi says:

    Are you going to let us ask your mom some questions? :-)

    • Daniel Smith says:

      Jessi: yes! Send them in! I think my mom and I are going to continue along like this, one-on-one, for another week or three. But then we’re going to try and open the floor up to questions. So send yours along …

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