The Most Common Mental Health Problem

Excerpted from
Triumph Over Fear: People with Anxiety, Panic Attacks and Phobias
By Jerilyn Ross

AT THE Anxiety Disorders Association of America, the calls and the letters pour in.

"I saw you on that program," says a woman who is calling from California. "The person you were describing - the one who couldn't sign her name in public - -that's me! I began crying - I couldn't stop - I had to call you."

"I've been terrified to leave my house," writes a man from New York. "I was so afraid. I couldn't tell anybody." (His handwritten letter goes on for twelve pages.)

"When the attacks first began, I was in terrible shape," another letter begins. "I didn't know what was happening to me. I tried to explain my feelings to my doctor; he didn't understand and told me I was fine. I truly thought I was losing my mind."

Another writes: "My phobias have been a very serious problem for the last fifteen years and have progressively gotten worse as the years go by. I have gone to all kinds of doctors and have even spent some time in the hospital to try and find out what the symptoms are or what is causing them. The frustrating part is when I am told that it is only nerves...."

"No one could tell me what was wrong," says a caller. "I'm one of those people who has to keep checking. It sometimes takes me two hours to leave the house in the morning; I check the stove, the lights, the doors. I have to keep going back...."

And almost everyone says something like "No one understands how I feel. I feel so frightened. I'm missing out on so much. I have no self-esteem left." Their symptoms differ, but all of these people suffer from an anxiety disorder. Over the past fifteen years I have worked with several thousand men and women with similar problems. They are some of the bravest people I have ever met. Every day they face situations that feel as physically and emotionally terrifying and draining as walking in front of a speeding car, jumping from an airplane without a parachute, or being trapped in a burning building.

To someone who has not experienced an anxiety disorder, the terror, discomfort, and irrationality associated with these conditions will seem incomprehensible. Having lived through it myself, I can say that there are few experiences in life more terrifying or baffling.

After overcoming my own debilitating phobia - the most common of the anxiety disorders - my dream was, and continues to be, to give others the new lease on life that I was given. Whether I'm working with an individual patient, talking to a self-help group, conducting a training seminar for health-care professionals, or appearing on television, my goals remain the same: to make sure that every American who suffers from an anxiety disorder knows that he or she is not alone, helpless, or hopeless; and to see that all who do need help have access to effective treatment.

Approximately 23 million Americans, 13 percent of the population, suffer from an anxiety disorder, according to the National Institute of Mental Health (NIMH). Although anxiety disorders are among the most treatable of all psychiatric disorders, fewer than one quarter of those suffering from an anxiety disorder receive treatment. Millions of others suffer in silence, or go from doctor to doctor, many having no idea what is wrong with them. And even if they do know, many are too embarrassed or frightened to ask for help.

But anxiety disorders are not costly only to those who suffer from them. As great a toll as they take on their victims, the toll they exact from society is perhaps even greater. Robert L. DuPont, M.D., president of the Institute for Behavior and Health in Rockville, Maryland, found in a study completed in 1993 that anxiety disorders are the most expensive of all mental illnesses.

Drawing on a new statistical analysis of a major survey of mental illnesses done in the early 1980s, DuPont and his team determined that anxiety disorders as a group cost an estimated $46.6 billion in 1990, almost one third of all costs for mental illness.

Almost three quarters of the total costs of anxiety, some $35.5 billion, were considered indirect, due to reduced or lost productivity. Treatment costs are comparatively low compared to those for such mental illnesses as schizophrenia or manic depression. However, the lost potential of those with an anxiety disorder, excluded from the cultural, economic, or social life of the country through fear and ignorance, cannot be quantified in dollars, and even the most conservative estimates can barely scratch the surface.

Those of us involved in anxiety-disorders research, treatment, and public and professional education are all too familiar with the gaps and frustrations in our health-care system: the inability of even some of the best health-care professionals to recognize the symptoms of an anxiety disorder and either to apply the appropriate treatment or to make an appropriate referral; and the lack of access for people with anxiety disorders to publicly funded mental-health facilities and to adequate health insurance to cover private treatment.

Over the years I have been repeatedly saddened by the stories of wasted years, wasted lives - real tragedies that could easily have been avoided. And yet the myths persist, principally the general misunderstanding that people with anxiety disorders are the "worried well," people whose problems are "all in their heads" and who should simply pull themselves up by their bootstraps.

There are the people with agoraphobia who spend years avoiding places where they have had panic attacks until they are afraid to leave their houses, or a single room in their house. Or they cling to a "safe" person who seems to offer protection against panic attacks, or who at least will be there "if the worst happens," whatever the worst is - often something that cannot even be expressed. Social phobics experience shyness that becomes a shackle, holding them back from any but the most minimal relationships, professional or private. These people spend lifetimes watching colleagues - often less talented, less able - surpass them professionally, watching potential friends, lovers, mates go off, never knowing what might have been had they not been effectively imprisoned by their inability to relate socially

Then, too, there are the victims who turn to alcohol or drugs to temporarily ease the terror or the shyness or the flashbacks and become doubly afflicted. And, finally, there are those who see no hope, who sink into a chronic depression and perhaps eventual suicide. The National Institute of Mental Health has estimated that some 70 percent of individuals suffering from one or another of the anxiety disorders has at least one other condition requiring psychiatric attention - including substance abuse - in addition to the anxiety disorder itself. Scientists call such conditions "co-morbid" conditions.

The disorders that are currently considered by specialists to belong to the broad category of anxiety disorders encompass panic disorder, phobias (including agoraphobia, simple phobias, and social phobia), obsessive-compulsive disorder, post-traumatic stress disorder, and generalized anxiety disorder.

Their true extent did not become known until the early 1980s, when the National Institute of Mental Health conducted the first-ever survey of mental illness in this country. Known as the Epidemiological Catchment Area (ECA) survey, it collected information from approximately 20,000 people in five cities: Baltimore, Mary - and. New Haven, Connecticut, St. Louis, Missouri, Durham, North Carolina, and Los Angeles, California.

The survey interviews were lengthy and detailed and generated data that became our most reliable source of information on incidence, prevalence, family history, age of victims, treatment, and costs related to mental illness. The survey continues to provide researchers with an ongoing source of information about mental illness and substance abuse.

One of the survey s findings was that anxiety disorders are the most common mental health problems in the country.
A more recent study, the National Comorbidity Survey (NCS) found the prevalence to be even higher than estimated by the ECA. One in every four survey respondants reported a lifetime history of at least one anxiety disorder. The NCS study's findings also suggest that anxiety disorders are more chronic than either depression or substance abuse.

Yet it was not until October 1991, at a National Institutes of Health consensus conference, that panic disorder, one of the most terrifying yet most treatable anxiety disorders, was officially recognized as a "real" and serious condition that can be effectively treated.

During the past decade a proliferation of newspaper and magazine articles, TV and radio talk shows, and books - both academic and self-help - has been tremendously helpful in raising our consciousness about the seriousness and the treatability of anxiety disorders.

Yet, as is evidenced by the more than fifty thousand letters received each year by the Anxiety Disorders Association of America (ADAA), a national nonprofit organization dedicated to improving the lives of people suffering from an anxiety disorder, the surface has barely been scratched. Millions of Americans remain in the dark about their condition.

Ignorance on the part of both doctors and patients, together with a widespread misunderstanding about the relation of mind and body, have been among the chief barriers to getting treatment for most of those who need it. These barriers are compounded by a tendency on the part of physicians (mostly male) and other professionals to ignore or belittle many complaints that affect primarily women, as do anxiety disorders. A wall of ignorance - and to some extent injustice - has separated those suffering from an anxiety disorder from those who could treat them.

To be fair, much of the knowledge about the disorders has only emerged in the past two decades, and much is still to be discovered - about genetic predisposition and about emotional and environmental factors that precipitate the disorders. The stigma that comes with mental illness in our society has yet to be dissipated. Indeed, many victims of agoraphobia cite "fear of going crazy" as one of the symptoms of a panic attack.

One of my chief aims in writing this book is to shed light on anxiety disorders, dispel some of the myths about them, and break down some of the prejudices. In Part One, I introduce you to five people (in addition to myself) whose stories illustrate each of the major disorders. These chapters focus on the problems of correct diagnosis and on outlining an initial treatment plan.

Part Two introduces another seven patients, including two children. Their stories will give you a fuller picture of the treatment process for panic disorder and phobias. It is now estimated that up to 90 percent of people with these disorders can be effectively treated.

If you, the reader, have an anxiety disorder, I hope the example of these courageous individuals will encourage you to reach toward recovery. With this in mind, Part Three is a self-help program that can be used alone or in conjunction with professional treatment, like the people you will read about here, you too can triumph over fear.