17 Nov 2015

The anxiety epidemic

12:26 pm on 17 November 2015

Unprecedented numbers of young New Zealanders are being diagnosed with anxiety disorders. So what’s it like to suffer from anxiety - and what could be the cause of it?

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Photo: Illustration: Toby Morris

Hazard lights ticking in the background, Dave is talking during his lunch break in the cab of a six ton freight-mover.

He spends his days driving the trucks across New Zealand, and had emailed a few days earlier.

“u might be surprised, but im a professor in anxiety,” he writes. “ive got 10 years knowledge on this subject. might have to charge u for my time”

Clad in work boots, Waikato stubbies and fluorescent fleece, he deftly rolls a cigarette and winds down the window for a drag.


It started out of nowhere, when he was 19, smoking a joint at a party. 

Dave was hit by a drug-induced anxiety attack as people talked and drank around him. Overwhelmed by a feeling of deja vu, it was like he was trapped in a series of scenes he couldn’t control or understand.

When he calmed down, he dismissed it as a bad trip, and headed home for a quiet weekend. A few days later another panic attack hit him as he was pulling into a park in his car.

He nods at the windscreen of the truck.

“It was like the windows of the cars were TV screens, like I was in The Matrix. Nothing felt real. My whole body would feel numb, and icy cold. I’ll want to stop everything and stay still. Feel trapped. Or just feel like running, but if you’re driving down the road, you’re in a position where you can’t run,” he says.

“For me, I only understood that my brain had gone ‘putt’.”

Thousands of New Zealanders every year find themselves confronted by the bizarre, often terrifying symptoms of anxiety.

Fear is swiftly becoming one of the most common health problems in New Zealand, with around one in five kiwis receiving a formal diagnosis of some form of anxiety disorder.

Already high, those numbers appear to be on the rise. Medication for anxiety and depression was prescribed to almost half a million patients in 2013, representing more than a 20 per cent increase from the five years previously.

For Lucy, the physical symptoms came long before she ever realised they had their roots in her mind.

It was like the windows of the cars were TV screens, like I was in The Matrix. Nothing felt real. My whole body would feel numb, and icy cold.

Lucy sits cross-legged in her lounge, where she lives with a collection of around 50 cacti and a ginger persian trimmed to resemble a tiny lion. She’s a singer, trained in jazz and now fronting a local electronic band, used to commanding a room. Thick, bright red hair reaches her hips, and she wraps it around one hand while she speaks.

It began when she was still a child: vomiting, dizziness, chest and stomach pains. Every time she went to a sleepover she would be hit by stabbing pains in her gut, until she was sent home crying.

“I didn’t understand what was going on - I would go to the sick bay at school, and I’m not sure how I understood it but I’d actually lose vision and have to lie down until it passed,” she says.

Back then, Lucy thought she could be suffering from an allergy, or some kind of undiagnosed illness.

“My skin would start to get cold and clammy, or really hot, and then it would come - this real sense of needing to escape. It was often irrational, but this need to flee whatever environment I was in.”

It wasn’t until she sought treatment for depression as a teenager that she realised her litany of symptoms could be a result of anxiety.

“To be honest, the term ‘panic attack’ wasn’t even on my radar until doctors introduced me to it.”

The sensations of fear - cold sweat, racing heart, adrenaline pumping - are survival mechanisms humans evolved over thousands of years.

Our panic response takes place in the amygdala, a part of the brain that sits low in the skull, identifying possible threats and preparing the body’s defences. Recognising danger, it overrides other functions to focus on the more basic priority of staying alive.

The brain floods the body with adrenaline, pulls blood flow to essential organs, raises heart rate, tenses muscles and deepens breathing, sucking in oxygen to prepare for fight or flight.

This causes the physical sensations of anxiety: a racing heart, stomach cramping, cold skin, and the feeling that you can’t form a thought as the mind races to identify threats. When  adrenaline levels ease back, after-effects include nausea, vomiting, loss of vision and memory, diarrhoea and hearing loss.

In the days of sabre tooth tigers, this response was vital to human survival, but today, it can do as much harm as good.

Belinda Stott has seen hundreds of clients with anxiety disorders in her ten years as a therapist.

“I think the simplest way to explain anxiety is “‘fear in advance,’” she says. It’s a panic response that has become come unmoored from circumstance, kicking in even if we’re not in danger.

What we have to remember about this part of the brain is that it’s a blunt instrument,” Stott says. “It’s not context-specific, and it’s not particularly sophisticated - so anything that happens in the present that even slightly resembles something scary, dangerous or traumatic that’s happened in the past, the amygdala tells the rest of your brain, “you’re in danger, you need to act”.

It’s also one of the fastest-acting parts of the brain, “so what we have is a situation where it’s not very accurate, it works fast, and it overrules the logical part of our brain. So we can be filled with adrenaline, panicking, stressed, ready to run, before we’ve even had time to consider things logically and go, “wait a minute - am I actually in danger?”

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Photo: Illustration: Toby Morris

Anxiety can present itself as mystifying physical symptoms, long before sufferers realise there’s a psychological cause.

Aroha is training to be a church pastor. She wears her hair in a blunt bob, and speaks quickly, precisely.

Years ago, she woke in the night with chronic pain in her chest. Her head spun. Her left side was tingling and numb. She tried to get up, falling as she left the bed.

“I thought I must be having a heart attack - I mean, the symptoms I had perfectly seemed to mimic a heart attack. And I thought, surely not, because I’m so young,” she says.

She was rushed to an emergency room, where they did tests, found her heart was fine, and sent her home.

A diagnosis for anxiety didn’t come until years later when she was hospitalised after a difficult birth.

“I was really unwell physically. I was bleeding, and had been for eight weeks. I couldn’t stand, lift the baby, walk. And then I stopped being able to sleep.”

She was awake for three days.  “I just started in crying and crying. I knew I couldn’t look after the baby. I felt like I was a lizard, like I just needed to lie in the sun to warm my body. That was how it felt physically, but it took a long time for me to connect those physical symptoms with emotion.

“I was thinking, I should just throw myself down the stairs. We were living on a hill section with a balcony and I could just jump off that. And then I knew, I knew that’s not healthy, that’s really bad.”

Her midwife booked her into psych emergency, where they diagnosed her with anxiety.

I felt like I was a lizard, like I just needed to lie in the sun to warm my body. That was how it felt physically, but it took a long time for me to connect those physical symptoms with emotion.

She spent two weeks as an outpatient, and was then admitted - but even after hospitalisation, recovery was an uphill battle. She was in hospital for 6 weeks before she could sleep again, she says.

“It’s like one of those over-sensitive car alarms that goes off every time a truck goes past - your brain is reading something as life threatening that isn’t life threatening, and responding accordingly.”

Aroha found some of the treatments for physical symptoms the most helpful. Massage, multivitamins, magnesium, breathing exercises and diets proved more effective for her than the cocktail of antidepressants she’d been put on earlier.

She used mindfulness and psychotherapy, and says now her anxiety is simply occasional background noise.

For some, anxiety seems to come out of nowhere. For others, a chemical imbalance can make them more prone to fear or panic reactions. But for most, Stott says, anxiety is triggered by an identifiable event - a past trauma or trigger that shakes their sense of safety.

People aren’t born anxious,” Stott says. “For most people, they go through something - their parents’ divorce, or there’s an illness in the family, somebody dies, maybe they’re abused or there’s a car accident - something happens and it breaks their illusion of safety, the innate sense that they are safe in the world. At that point a lot of people will adopt anxiety as a way to stay safe: they think, if I stay prepared and I think and I plan and I worry enough about this, I can make sure that doesn’t happen again.”

The preoccupation with staying safe and avoiding fear can become all-consuming, she says, as sufferers attempt to avoid triggers or future dangers, and slowly constrict their worlds.

When Dave’s panic attacks began, his world quickly shrank.

He’d always been a bit of a petrol-head, but after the panic attack in the carpark, found himself too afraid to drive.

He tried pinpointing anything that could be triggering his attacks and avoiding that.

“But to do that, I couldn’t function in life,” he says. “I couldn’t ride in cars. I couldn’t communicate with people. It was real difficult.”

It took him months just to get back to some semblance of normality - months of a quiet struggle to get his own head back under control. He now says it was one of the darkest times of his life.

Around 50 per cent of people with an anxiety disorder will also find themselves suffering from a mood disorder, like depression. Those with anxiety are also at a higher risk of suicide.

“I get now how it leads to depression, or being suicidal,” Dave says. “It’s almost like your worst fears are all coming true in your brain.”

He finally found his lifeline, not in mental health services, but religion. “I figured I had two options: I could go the medical way or go the church way. And I went to church.”

Dave says he found hope there that the future might be better. He also found a community of people to belong to.

“It’s like drowning, and you’ve got a life circle bubbling up the top of the water, and you’re just coming up for gasps of air.  I just held on to anything I could to not go crazy, and just bided my time.”

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Photo: Illustration: Toby Morris

Lisa* has slipped away during her lunch break at the real estate office where she works. She calls from a meeting room. “I’ve got 20 minutes,” she says. “Don’t use my name please. You never really know how people will respond to this kind of thing.”

She’d always been a top student - the kind who writes an essay early, and then goes back over it in red pen a day later. But as she studied for her masters, her mind started letting her down. She found herself unable to prioritise or make basic decisions.

“It’s like you have a million things to do but you can’t rationally decide how to do them,” she says. “Like looking at all these different lights and they’re all flashing at once, and you can’t pick one to focus on. Just overwhelming.”

As her workload mounted, she started having panic attacks, until six months into her thesis, her supervisor intervened.

“He basically said look, if you don’t deal with this you’re never going to finish your masters. And then [he] referred me to the university therapist.”

When she looks back on what triggered that awful year, the word that springs to mind is pressure.

“The pressure was huge, I think - I was working, I was studying, and my whole world was consumed with this one task: finishing the masters.”

She is echoed by Dave, who says he’s met a lot of people now who suffer from panic attacks too.

“I think there’s a lot more pressure for people now to be successful, get the house, the car, the boat, get married. It’s a lot, and maybe we’re harsher on each other too.”

It’s like a truck, he says, gesturing at the trailer behind him. “You put on one pallet, and then another one and another one, and blah, blah, blah. But what I’m saying is, you put too much on the truck, and it breaks.”

Stott says she’s noticed an uptick in the number of young people identifying with anxiety. Four years ago, she held a session on anxiety at a local youth camp, and 40 turned up. Last year, more than 1400 young people came to the same session, queueing for an hour afterward to speak to her.

It’s like a truck. You put on one pallet, and then another one and another one, and blah, blah, blah. But what I’m saying is, you put too much on the truck, and it breaks.

In the in 80s, the manual of the American Psychiatric Association stated two to four per cent of the population would have an anxiety disorder at some point in their life. In New Zealand, a 2009 study of young adults aged found 22.8 per cent had experienced an anxiety disorder in the past year - but when they examined the occurrence over their lives up to the age up to 32, that number rose to around 50 per cent.

“I don’t know if it’s more common now, but it’s certainly more talked about,” Stott says. “Maybe with our parents’ generation, our grandparents’ generation, they were more stoic about these things - ‘grin and bear it’, carry on, persevere. Today, people are more willing to talk.”

Anxiety can cost sufferers everything - their jobs, social lives, hopes. But Stott is startlingly upbeat about the way through.

“You weren’t born with anxiety,” she tells clients.  “You’ve developed it, or you’ve learned it somewhere. And if you learned it, you can unlearn it.”

Unless it’s biochemical thing, she says, then it’s attributable to  trauma, or patterns of thinking. Most of her clients, she says, “are overestimating the probability of the thing they fear happening, and they’re underestimating their ability to cope with it if it does.”

For many of them, countering their anxiety was a long process of thinking through: if the thing I feared happened, how would I cope?

Even those living with anxiety say there’s plenty of hope.

“Oh I’d say there’s certainly a way through,” says Aroha. “Absolutely you can learn to manage it, learn to recognise it, learn the strategies. For me now, it’s something that’s there and doesn’t affect my quality of life at all. Something that’s there in the background, like the hiccups, but I can [still] get on with things.”

Dave went down the mental health route too - seeing counselors, trying out medication, but says in the end, it was relationships that pulled him through. And while he’s through the worst now, his anxiety never vanished.

“Part of it is you have to come to a place of acceptance, whether you’re healed or not healed, you’ve still got to do life,” he says rolling another cigarette, and tapping down the stray strands of tobacco.

Even when you come out of it, when you’re in a good space, it’s like a ghost that haunts you - the realisation that it’s cost you so much, in your life.

“For me it’s been dreams of experiencing travel and different cultures - that’s been impossible for me, because I couldn’t handle getting on a plane, or the thought of being in a country I didn’t know and having a panic attack.”

It takes away things that he’d always thought would be part of him, he says.

“You can’t change it. The time’s gone; you can’t go back.”

*Some names or details may have been changed to protect identities.

Want to talk?

Lifeline - 0800 543 354  

Depression Helpline - 0800 111 757  

Healthline - 0800 611 116

Samaritans - 0800 726 666

Suicide Crisis Helpline (aimed at those in distress, or those who are concerned about the wellbeing of someone else) - 0508 828 865 (0508 TAUTOKO)  

Youthline - 0800 376 633, free text 234 or email talk@youthline.co.nz