Anxiety disorders are among the most pervasive of all psychiatric disorders listed in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders and are the most prevalent mental disorders in the United States. Issakidis and colleagues (2004) estimated that the cost of care for anxious patients was $400 million. Similarly, Greenberg and colleagues (1999) estimated that the annual societal costs of anxiety disorders exceed $42 billion dollars. Aside from the obvious genetic predisposition required to develop a full-blown anxiety disorder (see previous post on family anxiety, such as "my momma taught me how to fear"), we also know that there are a host of environmental factors that are critical for the process of anxiety, which we all experience, to develop into a disorder of anxiety. Although the process of anxiety is undoubtedly universal and occurs in all cultures, diagnosable anxiety appears to affect Western society, in particular us Americans, more than other cultures. This implies that there is either (a) something completely wrong with how we conceptualize anxiety or (b) that there are factors that are characteristic of Western culture that are largely absent/not as pervasive in non-Western cultures. Science has clearly supported the latter view and we will now examine potential culprits as to why we are so bound up with anxiety disorders in our society.
"Keeping Up With the Joneses" or the Normalcy Bias
My friend Charla Young, host of the new show "Power to Change" addressed the Normalcy Bias in a recent show. Individuals on the show discussed how they went from living a prodigal lifestyle to a much more frugal one and how this was extremely liberating. The common thread in those of us who succumb to the normalcy bias is attempting to live above our means, trying to keep up with others who appear more successful, that money is the key to happiness, and that I will be accepted if I have more things. Quite frankly, we don't find the normalcy bias in largely collectivistic/non-Western cultures to the extent, if at all, in Western culture. One of the interesting facets of our culture in the United States is that many of us share ideals that are both individualistic (largely Western) and collectivistic (largely non-Western) due to families of origin. This notion becomes extremely important in combating many of the sociocultural factors that contribute to our anxiety, since many of our collectivistic values (selflessness, interdependence, concern for others, "it takes a village to raise a family") hold the key to breaking us from this vicious cycle. As previously noted, anxiety involves thoughts of uncontrollability and unpredictability of upcoming personally salient events, a shift in attention to our inability to cope, memory of negative aspects of certain events, and negative emotion. We can see the normalcy bias at work here particularly if we are excessively concerned about the views of others and our being. Without a shadow of a doubt, Westerners are conditioned to equate things with success (more below). Unfortunately, when we are unable to obtain "things," based on environmental expectations, the media, and what others tell us, we often feel empty, anxious, and insecure. Selflessness is a phenomenal antidote to this problem, but we have to become conditioned to being selfless just as we became conditioned being concerned only about ourselves.
The need for achievement can be construed as a social need that directs people to strive for success and excellence, accomplishment and influence. No one could argue against the notion that most Americans are conditioned to be very high in achievement motivation, with many of us learning over time that high achievement = happiness. The caveat here is that many of us share both individualistic and collectivistic values. However, the biggest issue is that many of us place our favorite teams, careers, family expectations, and abilities as the most important parts of our identities. Conjure up an image of your favorite collegiate athlete who "lost the big game," and the grimacing pain on his or her face--as if a loved one were unexpectedly taking from the earth and cast into eternal damnation. Now granted, I am a huge sports fan and former collegiate athlete, however my collectivistic values fortunately prevented me from equating my identity to my success in track and football. Had I, I would be miserable in at least one of these sports. Similarly, I was able to have closure when "retiring" from collegiate sports and tapping into the next chapter of my life only because I did not equate athletic success and failure with my well-being. For example, think about that friend, family member, or colleague who may attack you if you make light of their (fill in the blank). Moreover, when these individualistic factors are inconsistent with our reality, the cycle of anxiety is often perpetuated causing us to react as if we are in a dangerous situation when we are in fact not. A lifetime of high achievement motivation coupled with trying to "keep up with the Joneses" is a recipe for disaster. Winning is awesome, success is great, and having things is nice; however, I refuse to be a part of the $42-billion dollar problem due to cultural expectations to be better than others.
(DSM-IV; American Psychiatric Association, 1994)
(Nietzel, Speltz, McCauley, & Bernstein, 1998)