By Dr. Colin Michie of AUC Medical School
Dr. Colin Michie has worked as a paediatrician in the United Kingdom, Africa, the Caribbean and the Middle East. He is specialised in nutrition, haematology and infectious diseases. Now the Associate Academic Dean for the American University of the Caribbean Medical School in Sint Maarten, his enthusiasm is training medical students and healthcare teams to ensure they deliver better value health care.
Do you wake up calm and prepared for the day ahead? If so, how often do you remain like this until lunchtime? Whether you go to school, have a job in the community or work at home; whether you care for others, work as part of a team or pursue problems alone, it is valuable to be calm. Likewise, how did you sleep? Did you need an alarm to wake up? Did you enjoy your breakfast? All these questions help review our inner state of balance. St. Maarten’s sunshine, its amazing colours and scenery are reassuring; but do we feel relaxed inside?
Students in our medical school often come to talk about difficulties they have with their studies. When faced with the challenges of course work and assessment, they discover that they no longer rest, cannot manage to eat on a regular basis and they report that they waste time and have problems concentrating. They “freeze up” on exams, searching for answers to questions for which they thought they had prepared. They describe being “stressed” and “suffering” whenever they think about the multiple challenges associated with a medical education.
These problems that we generally label as anxiety are commonplace. The very word “anxiety” is frequently used in the media and new versions of the label are readily concocted, such as “wedding anxiety”, “pre-election anxiety” and “kitchen anxiety”.
Have our 21st century skins become too thin to protect us from the challenges life throws our way? Some suggest that the media generate anxiety. We are bombarded almost daily with reports of disasters, health scares, warnings about climate changes or threats from international politics. Advertisements create anxieties, suggesting we can solve life’s problems by shopping. Perhaps some working environments are difficult: “I am stressed out”; “Life is always a rush”; “I am frustrated: I try hard but it is never hard enough”; “I hate my job”.
Significant causes of uncertainty and anxiety include migration or financial insecurity. Those from another island will have left their family and social networks behind; they have become immersed in new cultures with differing challenges. Lumping these many conditions under the negative term of “anxiety” is not always helpful. We all need some anxiety. Lewis Hamilton takes his Mercedes to the pole position at the start of a Grand Prix almost certainly with some anxiety or stress; Les Bleus, when facing the finals in Russia showed some uncertainty earlier this year.
So there are situations in which our mind and body will, as an understandable response to a possible future threat, make us nervous. These situations raise our pulse rate, dilate the pupils of our eyes, make us sweat and tie our stomach in a knot. This is normal, natural and appropriate. It is a response generated by the nervous system and the adrenal glands (collectively known as the sympathetic nervous system). Kierkegaard wrote, “To venture causes anxiety” and he described anxiety as “the dizziness of freedom.”
There is an optimal level of anxiety for any situation. Psychologists sometimes refer to the “Yerkes-Dodson law” that links physical and mental arousal with performance. Essentially, a little bit of arousal is a good thing – it will help you pay attention and perform better – but too much arousal almost always impairs performance.
If anxiety becomes a regular part of our lives, or if we begin to consistently avoid situations in which we know we become anxious, life’s normal rhythm becomes impossible. At this point, anxiety becomes a clinical disorder. In some situations, anxiety can cause panic attacks, irrational fear or psychiatric symptoms. Over time, anxiety is likely to trouble your stomach most often causing indigestion.
Worrying overmuch about our own health can readily make us imagine symptoms: this is called hypochondriasis. Our responses to anxiety can, if repeated and extreme, result in other mental health problems. Real rates of anxiety are difficult to measure, but several national reports show just how common it can be. A large community study in the Netherlands found that a third of adults will suffer with clinical anxiety or depression at some point in their lives. A similar rate of 29% has been reported from the United States.
The development of anxiety is most closely linked to the local socioeconomic, physical and social characteristics of where we live. The problems of low income, traffic noise and a lack of security were identified as being more important than, for instance, the numbers of people living in a neighbourhood.
A French study of workplace found that 52% of employees showed high levels of anxiety, while 16% were suffering from an anxiety disorder. In the United Kingdom, various studies suggest that perceived isolation contribute strongly to anxiety: 80% of caregivers, 58% of immigrants, 50% of the disabled and 33% of elderly people describe themselves as being lonely. Therapists have reported that anxiety disorders are the most common problem seen in Europe.
Dr. Michie expresses thanks to Dr. Danny Wedding, Consultant Clinical Psychologist and Senior Faculty at the AUC, for his editing of this document.
Continued in the next edition…
