Gateway to all adult mental disorders
Posted Apr 26, 2017
I recently watched Charlie Rose interview a panel of three mental health experts. They found that, starting at age 4, 9 percent of preschoolers presented with Childhood Anxiety Disorder, Separation Anxiety by age 6, Generalized Anxiety Disorder by age 10, and with an overlay of Social Anxiety during this time period. There is evidence that these early anxieties build upon one another, becoming the gateway to Bipolar, Schizophrenia, and all adult mental disorders.
It was reported that one in every 5 young adults, ages 18 to 28, experienced an anxiety episode during the last 12-month period, preventing them from adapting to the challenges of adulthood. Although anxiety is a normal human emotion necessary to protect us against danger, the inability to cope with anxiety becomes greater over time, since any intervention must first deal with the maladaptive and often self-defeating coping mechanisms learned along the way.
The experts found no social stigma associated with Childhood Anxiety other than from parents who refuse to acknowledge it. Children can suffer for 2 to 7 years before parents accept the problem, and then begin to comfort and overprotect the child, preventing the child from learning to cope. Childhood symptoms might be stomachaches before going to school, too much time spent on computer games, and avoidance of many everyday encounters. But it was among the young adults that major problems occurred, such as academic decline, depression, and self-destructive behaviors.
The panel made mention that the brain’s hippocampus is instrumental in helping overcome anxieties, but did not allude to what may have precipitated Childhood Anxiety in the first place. I would venture to say that it could be an inability to cope in the face of an overwhelming fearful incident emblazoned within the brain’s amygdala, which can run the lifespan.
I am reminded of Audrey, a 27-year-old mother of two boys, the oldest being diagnosed with Attention Deficit Disorder. Audrey was on sick leave as teller from a major bank. Her husband was an office worker for a municipal electric company. Audrey had been driving to her job one morning, after dropping off her oldest son at day care, when she suddenly felt a tension in her upper chest, her heart racing, and panic.
She was diagnosed with Panic Disorder and referred to me for psychotherapy. Her husband was fully supportive and suggested that Audrey quit her job, that they could get by financially. But Audrey felt that she must work.
In therapy, it became evident that the precipitating factor for the panic was the bank manager, who insisted that Audrey work Saturdays. Audrey was already at her limit, getting up in the morning and preparing her younger son for day care, while the older boy would talk back and act out. She would be docked and hassled by the manager if she were late for work, and she had to sit on the same stool, at the same window, recite the same sales message for loans to all customers, not leave her station, and take a late lunch. Before coming to Pennsylvania, she had worked on an assembly line dressing chickens in Delaware, and swore she would never go back to that.
Audrey was subsumed with anger, yet she could not stand up to male authority. When probed, she related that when she was about five, her father, a prison guard, got drunk one night, took out his 38-cakiber revolver and shot at her mother’s feet, making her mother dance. Audrey’s father, when sober, was a righteous, hard-working man, who took his anger out on prisoners. Audrey took on her father’s work ethic and buried her anger at her father, along with the fear she had of him.
Audrey was not just afraid of male authority: she was afraid of her own rage, on which she felt she had to keep a tight lid for fear of killing someone, namely her older boy and her boss. The greater the anger, the more pressure she placed upon herself to conform to authority. There was absolutely no legitimate way to express her anger. When the stress became altogether too unbearable, she panicked.
Fortunately for Audrey, her father and mother were still living, although her father had recently suffered a stroke. Audrey had not seen them since her marriage, about ten years before. Audrey and I arrived at a plan for her to return home for a visit and, while there, to confront her father face-to-face for having terrorized her as a young child. Audrey initially objected because her father, she believed, would just belittle in incident. I role-played her father, however, and Audrey started telling “her father” what he had done to her life.
Audrey practiced telling her father that she loved him, and would always love him, since he was her father, but that he had terrorized her as a child and that she was very angry at him for this. I, as her father, would answer, first denying the magnitude of the incident, then blaming the whiskey, then blaming Audrey for misunderstanding the situation, and finally by becoming angry and verbally abusive. Audrey practiced talking to “her father” for about three weeks before she was ready for the confrontation. Audrey’s husband took the week off work and drove her and the boys south for the reunion.
When Audrey arrived, there would be additional conflict with the brothers and sisters who had not left home, but Audrey conspired with her mother to be alone with her father one afternoon. She was over-prepared, ready for almost any maneuver, yet also prepared to lose. Even if her father successfully turned the tables on her, at least she would have told her father how she was terrorized by his repeated hostile behavior toward her mother. Audrey agreed not to try to change her father; he would still have his guns, still treat her mother in a demeaning manner and still rage on as ever.
Audrey and her father talked for over two hours. She got everything she wanted to say off her chest and he apologized for having hurt her. Audrey re-established her caring relationship with her mother, inviting her to visit Pennsylvania. And, after seeing her brothers and sisters who had not left home, Audrey was able to see how far in life she had come.
Back in Pennsylvania, Audrey was beset with only one panic attack, which followed her older boy’s talking back to her. She had somehow “seen” the boy’s bellicose manner as reminiscent of her father’s. Audrey returned to work at the bank, and was ready, if necessary, to confront the manager. The manager had since been transferred, however, for making improper sexual advances to female employees.
This blog post was co-published with PsychResilience.com