Monkey Mind

AIM 21.4.13

 (Excerpt from song, ‘High Anxiety’)

Woody Allen:  If I have a brain tumour I don’t know what I’m going to do.

Woman:  You don’t have a brain tumour; he didn’t say you had a brain tumour. 

Woody Allen:  No, naturally they are not going to tell you because sometimes the weaker ones will panic if you tell them.

Woman:  Not you.

Woody Allen:  Oh God, I hear a buzzing, is there a buzzing?

Lynne Malcolm:  New Yorker Woody Allen angsting over anything and everything in his classic comedy of the 1980s, Hannah and her Sisters.

I’m Lynne Malcolm and I’m very pleased to be back with you for a new season of All in the Mind. Today, we meet another anxious New Yorker who has what he calls ‘a monkey mind’.

Daniel Smith:  ‘Monkey mind’ is a term that the Buddhists use to describe a mind that is out of control, in which the thoughts are acting the way excitable monkeys in the jungle act—swinging from vines, screeching, never stopping moving.

 I had not come across anything that captured the feeling of anxiety in quite that way before.  Anxiety is by far the most common psychiatric complaint.  Double the amount of people go in for the treatment for anxiety as go in for treatment of depression. And of course those two are opposite sides of the same coin, as my therapist mother likes to say.

Lynne Malcolm:  Daniel Smith, author and professor of English at the College of New Rochelle in New York.  He’s had a lifetime of intense worry which he’s written about in his recent book Monkey Mind: A Memoir of Anxiety.  Despite the fact that chronic anxiety can have its funny side, even in the eyes of those who experience it, it can also be devastating, as Daniel Smith has found.

Daniel Smith: It feels, when anxiety is really acute, as if anything around you is a terrible threat to you, catastrophe is about to befall you. Anxiety is a state of nervous vigilance; you look around for the source of it and it could be anything. It could be the sandwich you’re eating for lunch, it could be the person that you’re living with, it could be the job that you’re in the middle of trying to do. So everything falls into doubt, you sort of burrow into the self so that all you can see are those anxious thoughts and those anxious feelings, and the feelings are particularly hellish.  They mean a heart rate that increases uncomfortably, hyperventilation, sweating, shaking, a sense of unreality, limbs that tingle. For me, it was very often a sense of something cold and sharp on the inside of my chest.

Lynne Malcolm:  Tell me about when you first experienced it. You were still at school weren’t you, you were a teenager when you realised that it was becoming a real problem?

Daniel Smith:  Sure; I mean, I assume this is a family program so I have to be a little bit circumspect.  I was 16. I had been a pretty nervous kid but the anxiety hadn’t really impeded my life in any notable way.  I had little phobias, I had little ticks maybe worse that the common bear, but lots of kids have little fears and little ticks. And when I was 16 I lost my virginity in a circumstance that many young boys would find to be glorious and wonderful and ennobling.  I lost my virginity to two older women and thought that this would be fantastic, and yet it launched me into my first period of really acute, constant, seize-you-by-the-shirt-lapels anxiety. 

Part of it was that I feared that I had contracted HIV, which is a very common fear for those who are anxious—not HIV in particular but some disease.  And another one was simply that I felt I had squandered something; I felt as if there was some script that a young boy should go through and that I had broken that script. And the thoughts began to tumble one after the other in a horrible way.  It was almost overnight that I lost my ability to function as I had before and anxiety became a constant presence in my life. And I really mean constant; I mean, I would wake up anxious, I would be anxious all day long, thinking thoughts of catastrophe and death and misery, and I would go to sleep anxious and I would dream anxious dreams. And I would wake up anxious again the next day.

Lynne Malcolm:  So when does anxiety become abnormal? It is a normal part of human emotions isn’t it?

Daniel Smith:  Yes, it is, it’s a necessary part of human experience.  If we hadn’t been anxious when we were evolving on the African plain, lions would have eaten us.  And if we weren’t anxious now, we would get burned by the hot stove more often than we do, or get hit by cars more often than we do. 

But there’s a very thin line, I found, between anxiety that is useful and the anxiety that takes over. A switch can flip very quickly.  I know it’s a problem when you can no longer control your thoughts and the thoughts are controlling you.  And it still happens to me almost every day. I will wake up fairly optimistic, fairly capable, fairly focussed and then by around 3 o’clock in the afternoon, the effort to exert my own focus and my own control falters and the anxious thoughts start to take over, and I have to stop myself and actually deal with deactivating those thoughts as if they’re bombs or mines in a minefield.

Lynne Malcolm:  It’s important to distinguish between normal day-to-day worry and an actual anxiety disorder, in the same way that we distinguish between a diagnosis of depression and just feeling a bit sad or down. An anxiety disorder involves a degree of distress caused by persistent excessive worry that isn’t justified. It can manifest in a range of forms, including obsessive compulsive disorder, agoraphobia, social anxiety and panic attacks. 

This anxiety often seems to come out of the blue but what is research showing about what causes the disorder?  Dr Paul Morgan specialises in this area at Sane Australia and, as you’ll hear shortly, he’s also had personal experience of it.

Paul Morgan:  The reasons aren’t completely understood, but in recent years we’re starting to understand it much better.  It’s an interaction between a genetic predisposition, a genetic vulnerability or sensitivity to developing the disorder, plus regular personality treats; some people just tend to be a bit more carefree than others, some tend to be a little bit more worrying than others.  That’s part of the normal spectrum of human psychology.  And thirdly, there are environmental stressors, just the pushes and shoves and pressures of daily life. And you might not have a genetic predisposition and you could put up with a certain amount of pressure and you wouldn’t get an anxiety disorder; someone else who experienced exactly the same pressures and if they did have a disposition towards it then they would then start to develop the disorder. So it really is a question—and we always stress this—of not either or, but it’s of the two factors interacting.

Lynne Malcolm:  And what’s known about what happens in the brain when people experience extreme anxiety?

Paul Morgan:  Well, as I mentioned, some research is beginning to indicate that a component of anxiety is these genetic predisposition, so there are some chemical messengers which are associated with a flight or fight mechanism that we know about, which is a very basic survival trait. But the trouble is for someone with an anxiety disorder there’s no brake on that.  It’s as though there’s a big red button inside your brain that says, ‘Panic. Get the heck out of here,’ and that this button has somehow got stuck down when you have an anxiety disorder. And your brain is going, ‘It’s an emergency, it’s an emergency,’ but it isn’t.  And you can tell yourself that, but still these chemicals keep flooding through the brain sending out this message: ‘It’s an emergency! Empty the building,’ as it were.

Lynne Malcolm:  You’ve had personal experience of anxiety. How did it manifest itself and how did you get to the point of getting some help?

Paul Morgan:  I think probably I’ve always been a perfectionist, to put it mildly, and slightly obsessive about things from childhood. That was probably just a personality trait, but certainly when I was, many years ago now, working on a number of projects very hard—I was staying late a lot of nights during the week, I was working a lot at weekends, putting myself under a lot of pressure—and I must say it was myself putting myself under pressure, it wasn’t anybody else—and it just got into a spiral where I just became anxious about everything. 

And if one thing was worrying me and that was dispelled and sorted, then within minutes, it seemed, something else would become a big obsessive worry. It was just the anxiety projecting itself onto different situations, and eventually it became almost irrational.  I’d wake up in the morning feeling guilty, strangely guilty, as though I had committed some awful crime. But I was pretty sure I hadn’t committed a terrible crime, but the feeling of anxiety remained, that I’d done something bad and I was going to be somehow punished or hauled in front of a room about it and subjected to questioning.  And I thought, ‘This is absolutely ridiculous; what on earth is going on here?’  And of course these needless feelings of guilt are an actual symptom of an anxiety disorder. And I should have known that, but, you know, self-examination is the hardest thing of all, as we know.

Anyway, it got to the stage where I just said, ‘I’m going to go and talk to my GP about this and just be totally frank and tell him everything I’ve been thinking.’ Of course GPs these days are very used to dealing with mental health problems—I believe it’s about 20 per cent of presentations to GPs have a mental health component. In recent years they’ve had a lot of extra training and assistance in working with mental health problems and providing referrals for psychiatric help. So I had a good referral and I was able to get some psychological help. And really I think it’s no exaggeration to say that that changed my life, because something inside of me just relaxed and really the worst of that anxiety just melted away through that therapy I experienced.

(Music)

Lynne Malcolm:  Dr Paul Morgan from Sane Australia. In his investigations for his memoir of anxiety, author Daniel Smith has found there’s an interesting connection between anxiety and one’s sense of freedom.

Daniel Smith:  Kierkegaard, Søren Kierkegaard, who wrote the first book about anxiety—and a terrible book, really unreadable—he believed that anxiety and freedom were intimately and directly linked, that whenever you experience a bit of anxiety, what’s really going on is that you have faced something regarding your freedom, you had faced a decision, a choice, you’ve reached the crossroads. And of course if you’ve reach a crossroads, you can only take one of those paths, you can only go down one road.  So you immediately slice off the possibility of the other, and this causes anxiety. 

So he thought that the people who are very, very anxious are more aware of freedom and therefore were greater human beings, which I don’t ascribe to. I don’t think that the more anxious you are the better human being you are.

But I do think that being faced with a choice is often very anxiety-provoking and is often strangely, in a kind of modern industrial, commercial culture, the time when anxiety comes a lot of people experience anxiety in the breakfast cereal aisle of the grocery store—‘Do I choose Rice Krispies or do I choose Cheerios?’—this feeling that choices are far more consequential than they actually are.

 It seems comic but we are met with so many choices now; the internet has broken this wide open, there are so many options, and the result is very often a sense of paralysis and a kind of extended adolescence. If I choose one thing, I am closing off a thousand other lives and that can be very terrifying.

A lot of people say that we live in the age of anxiety. I’m not convinced that our age is more anxious than previous ages. I did a little reading up on the fourteenth century, which was a period in which people’s uneasiness spiked terribly, for very good reason; there were roving hordes of mercenaries in the countryside, there was the black plague which wiped out nearly 50 per cent of the population of Europe, there was a traumatic schism in the church, there were all sorts of terrifying things going on—war, famine—now that produces anxiety.  We don’t have much of that, at least not in Brooklyn in 2013; then again, we do live in an age in which we know more, and knowledge can be very anxiety provoking.

(Music)

Lynne Malcolm:  You talk about how this sense of anxiety interacts with love and relationships with others. Tell me a little bit more about that and what it’s like for the other person as well as for yourself.

Daniel Smith:  I’ve come to believe that that’s truly the worst thing about anxiety, that for all the sense of distress, for all the sense of panic, for all the sense of things are going to go wrong, the absolute hell of anxiety is that inability to love, that sense of being locked into yourself.  Like the writer of The Diving Bell and the Butterfly, that beautiful memoir, Jean Dominique Bauby, who had locked-in syndrome, that’s what it can feel like. And so one has to work assiduously not to get to that point. 

How does anxiety interact with love?  In my experience, because when you’re anxious you’re always looking for a source of the anxiety—very often there is no source it’s simply undifferentiated sensation; some people have said that’s the distinction between fear and anxiety, fear has an object anxiety does not—the thing that you sometimes light upon is the person in front of you—your spouse, your partner, whomever—and you start to blame that person.

‘What if,’ you say, ‘if I wasn’t around this person, I would feel better?’ At the same time, you’re in so desperate and in so much pain that you want that person to comfort you. And when they do comfort you, say, you are horribly distressed by the fact that they can’t comfort you, because someone who loves someone who is very anxious can’t really do anything about it. People often ask me what can I do for my brother, my wife, my husband, my child who is anxious and it pains me to have to say nothing. It’s that person’s responsibility, or it’s up to that person to learn new ways. 

You can guide them toward those sources of wisdom, but you can’t do anything about it. All you can do is not take it personally, because you are not the source of anxiety.  You can’t stick around forever if it reaches that level of abuse where a person is pushing and pulling you away constantly back and forth as if in battered woman’s syndrome. You can’t do that forever, you can’t be a martyr. You ought not to say, ‘Calm down, snap out of it, feel better,’ because that does nothing but exacerbate the anxiety. 

But at bottom, the interaction between anxiety and love is that anxiety prevents love, it prevents you from seeing another human being.  You can’t see a person plain when you are consumed by concerns about your safety and your wellbeing–it’s impossible.  So it’s the enemy of love I found.

Lynne Malcolm:  Daniel Smith, author of Monkey Mind: A Memoir of Anxiety.

 I’m Lynne Malcolm with All in the Mind on RN, Radio Australia and online.  Today we explore the pain and the comedy of anxiety.

Woody Allan:  C’mon we’ve got a show to do. I can’t keep my mind on the show.

Woman: But there’s nothing wrong with you.

Woody Allan:  If there’s nothing wrong with me, then why does he want me to come back for tests?

Woman:  He has to rule out certain things.

Woody Allan:  Like what?

Woman:  I don’t know. Cancer.

Woody Allan:  Don’t say that, I don’t want to hear that word, don’t mention that while I’m in the building.

Woman:  But you don’t have any symptoms.

Woody Allen:  I’ve got the classic symptoms of a brain tumour.

Woman:  Two months ago you thought you had a malignant melanoma.

Woody Allen:  Naturally. I had this sudden appearance of a black spot on my back.

Woman:  It was on your shirt.

Lynne Malcolm:  You also talk about anxiety as one of the few mental illnesses that are actually funny, and I must say the book is very reminiscent of the type of Woody Allen humour that you see coming out of New York. Tell me about that connection with humour.

Daniel Smith:  Not only one of the mental disorders that are funny, but I think the only mental disorder that’s funny. You can’t imagine making a joke about paranoid schizophrenia or a joke about catatonic depression or about manic depressive illness – they are just not funny, or post traumatic stress disorder, but anxiety, everyone one knows that you can make a joke about anxiety and everyone knows that it’s been done very well by people like Woody Allen or by the film makers the Coen brothers or by any number of cartoonists and authors in the past. 

And I think that’s because the process behind anxiety is not only a kind of absurd process, but while you’re going through it, if you have any wherewithal whatsoever you know that it’s absurd. You know that it’s crazy to think that if you choose the wrong condiment on your sandwich it’s going to result in something horrible befalling you. You know while you’re thinking these things that they are not good for you or anyone around you, that they are a little off. And that awareness at the same time as you experience the pain can be funny if you’re aware of it.  I mean, not to diminish the pain, which can be exquisite and really horrible, but I find the use of humour to alleviate the anxiety–not long term; to alleviate anxiety long term you need to do a lot more than laugh. 

But Kierkegaard again, Kierkegaard had made the observation that anxiety and humour are diametrically opposed, that when you were anxious you were down in the level of the grasses, the weeds; you were so far looking at the details of everything, your eyes are opened to threats. Whereas, when you make a joke, when you laugh, as if the gods on Mount Olympus looking down at human beings scurrying around, you pull yourself up into the wide angle.  Those two views are opposed to one another, so when you laugh you have removed yourself from anxiety for that moment of that laughter. And I find that to be really useful and I’m grateful for it.

It’s also a way of disempowering the anxiety of saying, ‘You will not get the best of me; I am going to make jokes about it.’ So it’s a good way of kind of punching anxiety in the jaw.

(Excerpt from song, ‘Singin’ in the Rain’)

Lynne Malcolm:  Let’s get back to how you’ve been able to progress through developing some management strategies for yourself. You say that you’ve had as many therapists as King Henry VIII had wives: did therapy work?

Daniel Smith:  Therapy didn’t work for a while. Therapy didn’t work for a while for a couple of reasons—in the beginning because I didn’t really want it to work, or I wasn’t prepared to do any work myself.  Therapy also didn’t work because I had a number of therapists who kind of did what a lot of therapists do, which was ask you to talk it out, kind of release the steam from the steam valve, in the hopes that by doing so you will come to a point where these thoughts that are in you are no longer going to be inside you and aren’t going to be torturing you.  And that just doesn’t work for anxiety—at least it didn’t work for me.

The only thing that worked for me was when I found a therapist who had a real plan. He was a practitioner of cognitive behaviour therapy. The theory was when you experience anxiety, every time you feel that stab of anxiety and these horrible sensations you have thought something, you have said something to yourself. So the goal is to figure out what it is that you said to yourself just prior to feeling that stab of anxiety. It might be, ‘I am going to make a horrible mistake at work’; it might be, ‘My friend no longer likes me’; it might be, ‘My marriage is faltering’; it might be, ‘My child is in danger.’

 Once you’ve identified what that thought is, you can question it, you can kind of subject it to the scientific method, you could say, ‘Well, is it true? What is the likelihood that my child is in terrible danger right now? Well, probably fairly low. She’s at school at the moment.  Have there been people going to schools and shoot up the schools? Yes, but how often does that happen? Well, once every however amount. What is the safest place, according to studies, that are for children to be in? Well, public schools actually.’

 It’s like diffusing these mental bombs, as I said earlier. And the goal is to learn how to do that, to practise doing that. When you’re anxious, when you’re anxious like I am, you’ve carved out these mental pathways that are—after practising them so well, becoming so good at them, they are more or less permanent.  So what you have to do is find a way, find a discipline to change that pathway, to carve out a new pathway, and to keep doing that practice probably, for someone like me, forever. But learn a new method of thinking. The first step in this process is just mindfulness: pay attention to your thoughts, be aware of them, pick them up, look at them, let go of them. Recognise that they are not permanent and not necessarily the gospel truth; that’s not accurate.

Lynne Malcolm:  And also medication. It has been used extensively, it’s controversial; you’ve described it as ‘mummy surrogate’.

Daniel Smith:  Yes I’ve described Xanax. When I was a teenager and I used to take these Xanax with me into my high school and pop them when I was feeling very anxious and it kind of was like a mother nuzzling you and calming you and stroking your hair and kind of sanding off the edges. Things like Xanax or other what they call benzodiazepines, the anti-anxiety medications, they are fixes for the moment. They are like anything else that people use to alleviate their anxiety, from drink to sex, to distraction with TV or the internet or video games; they don’t change the way you think, they just sand down the edges.

Lynne Malcolm:  The anti-anxiety drugs, including benzodiazepines such as Alprazolam, Xanax, as Daniel Smith mentioned, can be addictive and there’s some concern about the safety of them when they are abused or inappropriately prescribed. In Australia, the Therapeutic Goods Administration is considering a reschedule of benzodiazepines to restrict their availability.

Dr Paul Morgan from Sane Australia emphasises that these anti-anxiety medications should only be used in extreme cases of the disorder.

Paul Morgan:  If someone is so severely affected by periods of profound anxiety that really cause them extreme distress, then as a temporary measure certain medications can be prescribed, which are called anxiolytics. And these are drugs that will relax you and they are really very pleasant to take. But any drug that makes you feel very pleasant, you have to prick up your ears about what’s happening. And a GP should and does only prescribe those for short term use.  Psychotherapy is much the best long term treatment for anxiety disorders.

Lynne Malcolm:  If you’re concerned about your own level of anxiety, or if you’re worried about a friend or family member, go along to your local GP for some advice, or call the Sane Australia helpline on 1800 18 7263. And I’ll put that number on the website, along with further information, including details of an app for your mobile device developed by Sane Australia, called Talking Anxiety.

But before we go, let’s get another tip from Daniel Smith and his monkey mind. 

Your brother also experiences a type of anxiety, which is hypochondria. Was it he that you recommend that you watch the movie Singin’ in the Rain?

Daniel Smith:  That was a different brother. Both brothers have experienced anxiety. My mother, being the proto-typical New York Jewish mother that she is, called me one day and said, ‘You know, you’ve written all this  stuff about Scott,’ my eldest brother who’s the hypochondriac, and my mother said, ‘Don’t you think David, your other brother, is going to feel bad that you’re talking more about Scott’s mental illness and not his?’ —which is a crazy thing to say. 

No, it was David during the third period of really terrible anxiety in my life, who called me and said, ‘I know you’re feeling awful. Here is what you should do, you should watch Singin’ in the Rain,’ which I thought was a terrible piece of advice. I had just gone through a horrible breakup and I saw no way out of it. And I was in one of those anxious states wherein everything suggested what was wrong with my life.  I couldn’t watch a television commercial without it pointing out everything I had done wrong and everything that was going to go wrong. 

And Singin’ in the Rain is about this beautiful romance, and I couldn’t possibly watch it. He said, ‘You think that, but watch it.’ And it’s incredible. It’s the most joyful thing. Since writing about this, other people have come to me and said,’ I’ve noticed that too.’ If you watch Singin’ in the Rain, it’s like two hours of the greatest psychiatric drug you can watch.  Something about the alchemy of elements of the songs and the dancing and characters, the comedy, is the perfect distraction from anxiety. So I hope that everyone goes out and watches Gene Kelly and Debbie Reynolds doing their thing.

Lynne Malcolm:  Daniel Smith.  His book is called Monkey Mind: A Memoir of Anxiety, published by Simon and Schuster,

Head to the All in the Mind website from abc.net.au/radionational for more information about the programs, and you can download the shows from there too.  And if you haven’t done it already, subscribe to the podcast via your iTunes library for a weekly update. Catch us on Facebook, too.

The sound engineer today is Timothy Nicastri. I’m Lynne Malcolm thanks for joining me, catch you next week.