Waiting to Exhalehttps://indianexpress.com/article/express-sunday-eye/waiting-to-exhale-anxiety-depression-mental-health-anushka-sharma-alia-bhatt-panic-disorder-social-phobia-6050314/

Waiting to Exhale

Why anxiety has become the prime disorder of our mindscape

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The National Mental Health Survey of India 2015-16 found that nearly 10 per cent of the population were affected by common mental disorders, including depression, anxiety disorders and substance use disorders. (Photo: Getty Images)

Gursimran recently disabled the read receipts facility on WhatsApp. “When you have these blue ticks, which tell that people have seen your messages and have not replied — that makes me very anxious. So, I decided not to care if someone has read my messages or not, or whether I know that or not,” says the 30-year-old, who works at a startup in Delhi.

His struggles with anxiety are as old as his professional career. A few years ago, a sense of being out of control led the IIM-Bangalore graduate to a psychologist. “I thought I was depressed, but the counselling psychologist said what I have is anxiety,” he adds.

Much of his anxiety revolves around the demands of his high-stress workplace. “The world can live with the fact that missing deadlines is normal, but I get anxious. If I am made to commit to a timeframe I know I can’t meet, I get stressed: What if I can’t do it? Does this mean that I am failing?” says Gursimran, who has worked in four companies in the last decade and finds workplaces unequipped to deal with mental health issues.

On a spectrum that ranges from nervousness to pathological and crippling anxiety, Gursimran possibly falls somewhere in the middle. But anxiety, when it manifests as a disorder, can throw life out of gear.

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Every time Delhi-based Aparajita Sharma, 24, travels to a new place, whether it is a work trip to Udaipur or a holiday to Europe, she gets a panic attack. “It is not travelling that bothers me, it is being in a new place. It is the inability to trust a new place and its people which makes me anxious,” she says. She describes a panic attack somewhat like this: “There are butterflies in my stomach, then my heart starts racing, there is nausea, and I get breathless. I feel like I am having a heart attack and I will not survive the day. When it happened once, I thought it’s physical, but when it happened whenever I was sent to a new environment, I realised there is a problem,” says Sharma, who is a project manager at Mind Specialists, a platform that works towards de-stigmatising conversations around mental health.

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The first step for family members is to understand when to prod others to seek help. (Photo: Getty Images)

“Anxiety is now the most prevalent psychological disorder in human beings,” says Dr Shwetank Bansal, consulting psychiatrist with Delhi’s BLK Super Speciality Hospital. It manifests as a pervasive sense of lack of control, and a feeling of being overwhelmed by the demands of daily life.

Anxiety now features in more conversations than ever before, with testimonials pushing for an acceptance of what is often not acknowledged enough in modern social systems — that human beings break down, especially when exposed to growing demands of performance and success. “As our encounters with anxiety disorder grow, as more people, including public figures, talk about it and as our understanding of its diagnosis and treatment gets more refined, it is natural for people to want it not to impede their quality of life,” says Dr Bansal.

According to a 2018 American Psychological Association survey, 54 per cent of workers under the age of 23 in the US said they felt anxious or nervous due to stress in the preceding month, and close behind were millennials, with 40 per cent of them reporting anxiety.

The National Mental Health Survey of India 2015-16 found that nearly 10 per cent of the population were affected by common mental disorders, including depression, anxiety disorders and substance use disorders. It quoted a study done in Himachal Pradesh, which revealed that 15.5 per cent of the population in the age group of 15-24 years suffered from anxiety.

It could be that everyday life, too, has morphed strikingly. “We don’t have a 9-5 lifestyle anymore; we certainly don’t have a five-day routine. Because of smartphones, you’re carrying work wherever you are, even before you sleep and after you wake up, so your mind is never switched off. That has increased the anxiety of everyday living manifold,” says Dr Samir Parikh of Fortis Healthcare.

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If you have plugged in to conversations about anxiety, however, you might discern a certain fuzziness to them — when everyday responses to stress also are clubbed with feelings of crippling anxiety. (Photo: Getty Images)

“There is a constant pressure of having a certain kind of job, salary or relationship. The idea that their life should look a certain way is making them anxious. But I think the younger generation has become more accepting of the fact that having a problem is normal and it is okay to seek help,” says Dr Anupriya Sircar, clinical psychologist at Max Healthcare in Delhi.

If you have plugged in to conversations about anxiety, however, you might discern a certain fuzziness to them — when everyday responses to stress also are clubbed with feelings of crippling anxiety. “Anxiety is essential, it facilitates our response to either fight or flee. If someone encounters a lion in a jungle, her anxiety makes her run for her life, till she is safe. But if the person cannot let go of the anxiety even when she is safe, is consistently worried and scared, that is how you understand that an anxiety disorder exists,” says Delhi-based counselling psychologist Manisha A Sharma.

Dr Bansal adds that it is crucial to distinguish between plain nervousness and a disorder. “Failing to do this can result in two problems. One, the medicalisation of the normal human experience of anxiety, and two, the opposite effect of trivialising the anxiety disorder of a person as something ‘that everyone experiences and needs to deal with’,” he says.

“One frustration with anxiety is that it is often hard to find a reason behind it. There may be no visible threat and yet you can feel utterly terrified. It’s all intense suspense, no action. It’s like Jaws without the shark. But often there are sharks. Metaphorical, invisible sharks. Because even when we sometimes feel we are worried for no reason, the reasons are there,” wrote Matt Haig in his book Notes on a Nervous Planet (Canongate, 2019).

One of the first public figures in India to open up about seeking treatment for anxiety was actor Anushka Sharma in 2015. “What’s the need to hide it?” she had said. Actor Alia Bhatt, during promotions for her latest film Kalank, also talked about her experience with anxiety. “I haven’t been depressed but I’ve had bouts of anxiety. It comes and goes… No matter how bad it is, I just let myself feel it. Sometimes, I feel like crying for no reason,” she said.

Earlier this year, Kolkata-based pop duo Parekh & Singh cancelled a music tour after vocalist and musician Nishchay Parekh opened up about dealing with performance anxiety. “I’ve been performing music on some sort of a stage since the age of 16. Even though I’m only 26, that amounts to a decade of performance. There have been extreme highs… However, another common thread has been anxiety, stress, and, recently, depression. I’ve been a natural performer and while I know that many live performers suffer from performance anxiety, mine just seemed to grow as the years went by,” he wrote on Instagram. The prospect of playing “big” shows pushed him over the edge, and he lost the joy and comfort he had once found in music.

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Sometimes, the trigger can be an unanticipated jolt of trauma. (Photo: Getty Images)

Last year, Tanya (name changed), 27, used to be anxious all the time — she could feel her heart racing, she was always tense. She was a lawyer then at a firm in Delhi, after which she moved on to do an MBA from a university in Karnataka. “I was facing a lot of pressure at my work and in my relationship, and to cope, I got into drinking. There was a point when I was either working or drinking. One day, I got extremely violent and angry. That is when I realised there is something wrong and I should seek some help,” she says.

Sometimes, the trigger can be an unanticipated jolt of trauma. Five years ago, for example, Sayoni (who uses one name) was working in the US as a journalist when she replaced by an American hire and given a day’s notice. “That changed everything I had planned. I had a student loan to pay off, I had planned a life and career in the US, but I had to move back to India,” says the Kolkata-based content writer, 30. Soon after, she developed psoriasis, a sudden inflammation of the skin.

“Psoriasis can be psychosomatic with roots in emotional trauma. I think that (firing) is the root of a lot of my anxiety. Since last year, I have started developing more intense symptoms. They particularly come at night, irrespective of how tired I am; my heart will be racing, I’ll break into a sweat, have palpitations and will be unable to fall asleep,“ says Sayoni. Despite that, she has not approached a counsellor or psychiatrist, but has chosen to be treated by a homeopath.

In his book, Haig wrote about his struggle to distract himself. “I was careful about what I ate. I did yoga. I tried to meditate. I lay on the floor and placed my hand on my stomach and inhaled deeply — in, out, in, out — and noticed the stuttery rhythm of my breath. But everything was difficult. Even choosing what to wear in the morning could make me cry,” he wrote.

He also listened to podcasts, watched new Netflix shows, went on social media, tried to get on top of his work by replying to all his emails. “I woke up and clasped my phone, and prayed that whatever I could find there could take me out of myself. But — spoiler alert — it didn’t work. I began to feel worse… I would stare at an unanswered email, with a feeling of dread, and not be able to answer it. Then, on Twitter, my go-to digital distraction of choice, I noticed my anxiety intensify,“ he wrote.

Passively scrolling the timeline felt like exposing a wound. He also read news websites but the knowledge of so much suffering in the world didn’t help put his pain in perspective. “It just made me feel powerless. And pathetic that my invisible woes were so paralysing when there were so many visible woes in the world. My despair intensified,“ he wrote.

In her book, Love and Rage: The Inner Worlds of Children (Yoda Press, 2017), clinical psychologist Nupur D Paiva, based in Delhi, busts the myth that children don’t get anxious, by illustrating the oblique ways in which it affects their behaviour.

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Parents are now paying more attention to the emotional needs of their children; in contrast, the previous generation did not acknowledge children’s anxieties as valid and important, says a clinical psychologist. (Photo: Getty Images)

Recently, a bright 15-year-old student had come to see her. “She was refusing to go to school as she would get panic attacks. She spent the day at home either sleeping or being on the phone. After seven sessions, we realised that she felt that she should not talk about her emotions or needs with her parents. She felt they were already struggling a lot with their lives and careers, and she must not overburden them,” she says.

Paiva is clear she doesn’t want to label children and teens with disorders while working with them. “For a child, it is an experience. My task is to look for what is making the child anxious,“ she says. “Four-year-olds think about god and death or wonder where babies come from; boys are curious about their penises. Parents tend to shut down those questions, but they don’t go away,” she says.

Peers are also an important aspect of an adolescent’s life, but social media has changed that dynamic. The circle that was previously limited to 10 friends and 30 classmates has now widened to hundreds, adding another reason for anxiety to amplify. “One of the reasons for anxiety is the fear of judgement. People are constantly looking at what you are putting on social media and forming opinions — there is a social media reality and you can choose it. People will like and it will determine how you will feel about yourself,” says Paiva.

But parents are now paying more attention to the emotional needs of their children; in contrast, the previous generation did not acknowledge children’s anxieties as valid and important, says Paiva.

For a culture rooted in relationships, the family remains a source of anxiety as well as solace. “I think the family plays a very important role because if they can give the space to the person where they are able to talk and feel understood, I think half the problem is solved,“ says Dr Sircar.

When Uma (name changed), 70, met counselling psychologist Manisha A Sharma, she had already been taking anti-anxiety medicines, prescribed by her general physician, but they did not help much. “She said she did not have any reasons for anxiety; but nevertheless felt anxious all the time. It was after a number of sessions that we found out that even after his retirement, her husband did not spend enough time with her. She had lived her life expecting that they would be together after he retires. But he was a workaholic, and found some other job to keep himself busy,” says Sharma.

For 52-year-old Anuradha (name changed), an associate professor in University of Delhi, a diagnosis of anxiety led to relief, but also criticism from her husband and friends. “They couldn’t understand my problems and said it happened to everyone… They said there was no need to go to doctors. They thought I was making it up,“ says Anuradha, whose mental health problems exacerbated with menopause.

The first step for family members is to understand when to prod others to seek help. “If you feel there is a drastic change in behaviour, if a very gregarious person now only keeps to himself, it is a cause for concern. If you see irritability or if you see he is getting low or getting angry, if he is anxious and constantly asking for reassurance, these are some signs which can tell you something is wrong,” says Dr Sircar. For those afflicted, her advice is simple: “If your anxiety is affecting your work, or sets your heart racing; if you tend to worry often about catastrophic outcomes, it is time to ask for help,” she says.

It’s taken a while, but Anuradha’s family and friends have come around now; she is on anti-anxiety medication and attends counselling sessions. “The support of my husband has been vital. He is careful about what makes me anxious, and that helps me manage my anxiety,” she says.

“The other day, I had planned to celebrate a friend’s birthday at work, but the teachers got agitated about an issue in the college staff room. I realised that my anxiety could increase, and before it did, I picked up my bags and left for home. The celebration could wait, but my anxiety would not,” she says.

What’s to worry?

Generalised Anxiety Disorder (GAD): The most common form of anxiety, it is an extreme, intense and absurd worry associated with everyday life. You will anticipate disaster about everyday things and experience fatigue, nausea, headaches, restlessness, insomnia and sweating.

Panic Disorder: If you get recurring panic attacks, it is possible that you have a panic disorder. Physical symptoms include rapid heartbeat, perspiration, dizziness, hyperventilation, chest pains and crying.

Social Phobia: Not to be confused with shyness. If you’re scared of being around people altogether, you might be experiencing social phobia, which is an intense fear of being in a social situation and being judged by other people.

Post-Traumatic Stress Disorder (PTSD): If you have experienced something traumatic in the past, and keep revisiting that memory, you might be going through PTSD. It can last for years, with physical effects including severe insomnia and constant fatigue.

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Obsessive Compulsive Disorder (OCD): If you tend to have certain thoughts or tend to do certain routines repeatedly and are unable to control them, you might be experiencing OCD. Eating only out of a particular plate may be mild OCD, but refraining from eating if that plate is not available is acute OCD.