As mentioned in the previous post, anxiety is one of the most prevalent and persistent conditions in the mental health field. The National Institute of Mental Health reports the number of US citizens at between 40 and 50 million persons. There is further evidence that more women suffer from anxiety than men. It is evenly spread over ethnic and religious backgrounds and is indiscriminate in its selection of patient sexual orientation. I believe that this number is very much an underestimation, and there are many people who I consider "silent sufferers". There are also conditions where anxiety is a part of another illness and remains under reported. For example, although alcohol is a central nervous system depressant, many of those with alcohol addiction also have anxiety issues that are simply not considered reportable. So, the issue of anxiety becomes a central part of our exploration of mental illness and it will take more than one post to fully cover the significance of this problem.
Anxiety occurs along a continuum from daily worries to being completely debilitating. We are all familiar with the stress associated with starting a new job, speaking in public, or any other number of life events that cause temporary anxiety. Generally, we accommodate the short-term distress, and move on with our lives. This type of anxiety is more like a reasonable fear in that it is focused, and has potential for being very short-term. But, the following anxiety conditions with a brief description have a more significant and long-lasting impact:
Panic Disorder: Patients with this disorder experience terror and a loss of control. It is anxiety that has no apparent trigger stimuli, causes sensations of rapid heartbeat, sweating, and sometimes chest pain, a desire to seek safety, and a sense that either a heart attack or death is occurring, and has no rational explanation.
Obsessive-Compulsive Disorder (OCD): Patients with OCD have ongoing thoughts and fears that cause them to perform rituals and routines that they believe will protect them from something dreadful happening. The thoughts themselves are considered the obsession, and the rituals are the compulsions. The classic example is that of the person concerned with germs who washes their hands continually despite the risk of any real infection.
Post -Traumatic Stress Disorder (PTSD): The issue of PTSD can follow any event involving trauma, such as the death of a loved one, sexual assault, military combat, or natural disasters. PTSD patients suffer frightening memories, and develop a numbness to the world around them.
Social Anxiety Disorder: This disorder causes patients to be overly concerned and worried when in a social setting, fearing to be judged and being embarrassed or ridiculed.
Specific Phobias: This condition involves an intense fear of particular and specific objects or situations. For example, fear of snakes, flying, heights, elevators, with the fear being disproportionate to the actual object or situation.
Generalized Anxiety Disorder: This is a condition where the patient has an excessive and unrealistic worry about almost anything in life. It is a pervasive condition where anything can be a threat.
As a case manager, I have been involved with all of these anxiety conditions and can attest to the fact that these are really just the tip of the anxiety iceberg. With the next post we will begin to look at each of these illnesses and I will share composite vignettes to illustrate these examples of anxiety.

In the previous post I suggested that a workable system exists for the diagnosis of mental illness. And, that remains true, but, there are several concerns about how the complete system really functions. To begin this post we have to consider how mental illness is first discovered, and what happens when there is evidence of an emerging problem.
Consider for a moment that as the early stages of a mental illness are observed, it will probably not be with a qualified mental health professional. It may be a parent, teacher, guidance counselor, friend, or family doctor who are the first to see some behavior that draws attention to the "potential" patient. Or, in fact, it may be the person with the problem who self-identifies and seeks assistance. So, it becomes very important when a problem emerges, that it is managed correctly. Unfortunately, this is not always the case.
Let us for the moment consider little Johnny sitting in the classroom. He is fidgeting, talking with other children, and not "behaving" as he should. The teacher makes an observation of the behavior and if it is occurring more than the teacher believes that it should, the guidance person is consulted. If it continues, the parents are asked to come in and discuss the inappropriate actions. And, at some point, the term ADHD (Attention Deficit Hyperactivity Disorder) may be applied as a consideration for the behavior. And, while it could simply be boredom, lack of interest, or an excess of sugar in the bloodstream, ADHD, the most over- diagnosed and over-medicated adolescent problem in the US will now be attached to this child. And, once the seed is planted, the label will stick.
Or, what will happen if an adult goes to the family doctor with symptoms of lethargy, reduced libido, and a general lack of interest in everyday life? (Recall that symptoms are what the patients describes, and signs are what the doctor observes). In this case the doctor can not see the symptoms, and can react to the report in several possible ways. The doctor can refer the patient to a mental health professional, suggest a "wait and see" scenario, or prescribe an anti-depressant. In many situations the medication approach is the easier of the alternatives and is frequently followed. Although the doctor is a trained professional, the most recent exposure to psychiatry was during  a clinical rotation in medical school. So, like many doctors, the biochemistry of the patient is not considered, but, may in fact be the cause. Unfortunately, after any discussion of depression with a doctor, the seed of depression is planted in the patient's mind.
In our stress filled lives with fast cures and medication, our culture fosters many incorrect and misleading conclusions about underlying reasons for mental health problems. And although what I have presented is a simplistic and quick view of system failure, it really is a cautionary vision.
So, despite the fact that we have good diagnostic guidelines in place, we are frequently victims of the structure and the culture of our society. We need a better way of communicating the recent advances in brain chemistry to those we trust with our mental health.
The next post will begin with anxiety, one of the most perplexing and prevalent mental disorders. It can be a stand-alone condition, but anxiety also accompanies many other illnesses.