Fear, Stress and Anxiety
The Biology of Peace and War
We are programmed to survive in two types of environments. The most common environment is safe and nurturing with pleasant climatic conditions and features a caring and harmonious social environment. The energetic flow between our innermost center and the outside world expands unobstructed which creates a sense of trust and pleasure. We are in the parasympathetic mode: “rest, relax, digest, defecate” and the pituitary releases the happy hormone oxytocin. These are normal conditions that humans sought to enable survival. However, at times, the environment becomes unfriendly or stormy, such as a war or an economical crisis. We sense danger, we do not feel safe and in the worst case, we feel that our survival is threatened. We cannot expand because we cannot trust the environment. We experience stress, get tense; we are extremely alert and have a hard time relaxing. We may even feel afraid and our body might go into the fight or flight sympathetic mode to deal with the threat to our survival.
The parasympathetic and the sympathetic systems are two branches of our autonomic nervous system, which is part of our unconscious survival make up. The parasympathetic system helps us to survive in times of peace and quiet by generating a pleasurable sensation that feeds our will to live and the sympathetic system supports us in times of threat by initiating an emergency survival behavior, the fight or flight response. These two systems are composed of specific sets of nerves, hormones and neurotransmitters.
The Sympathetic and Parasympathetic Systems
The sympathetic nerves communicate signals via stimulatory neurotransmitters and the parasympathetic system via inhibitory neurotransmitters that prevent the nerves from firing. They have opposite effects on our cardiac, digestive, respiratory, sensory, elimination systems and our mental/emotional states. In daily life, these two systems are cooperating with each other to support minor stressors such as moving from a laying down position to a standing position for instance.
Notice that the fight or flight response is not a fear response. The human fear response would be to freeze and shake and be vulnerable. Fear makes us powerless where as the fight or flight response empowers us and enables our survival.
Stress and Anxiety In Our Modern World
In today’s world we deal with a different type of stress. The archaic stress response to the fear of external danger may be outdated, but the fear of not having enough, or the fear of intimacy, or psychological neglect for an adolescent, may cause the same physiological stress response. Our modern lifestyle with deadlines, alarm clocks, TV’s and telephones puts pressure on us interrupting our natural biological rhythms. The body might also be assaulted by free radicals caused by environmental contaminants, loud city noises, or the constant process of avoiding a prior physical or psychological trauma. In any case, when our brain perceives a danger, whether this danger is real or not, the brain activates the stress hormone cascade producing their deleterious effects on our body systems. This perception of a constant threat to our homeostasis gives rise to a feeling of hypervigilance, discomfort, and worry: anxiety.
Normal Anxiety and Anxiety Disorders
Some level of anxiety is normal in everyone’s life. Unusual and important circumstances out of the ordinary of daily life such as getting married, public speaking or taking exams can generate anxiety in a large number or people without further future negative consequences. However, when anxiety continues without an obvious cause, a pathological mental state settles in. For instance, if someone has a negative physiological response to monosodium glutamate (MSG) after eating in a Chinese restaurant, they may not want to go to any restaurant and restrict their foods to foods they know for fear of having a similar reaction to a new food. The world becomes a hostile place to live in and each time they eat they experience anxiety, anticipating a negative reaction. In this case, we are dealing with an anxiety disorder.
When to Treat Anxiety?
We must accept that the line between normal and pathological states can be very blurry.
In normal circumstances, the life force manifests with a pleasant physical sensation, a positive state of mind and trust in the environment. When this trust is broken pleasure can turn into anxiety. Anxiety is a feeling of anhedonia and mistrust in the environment. Anxiety is related to fear and fear is at the core of anxiety. Fear is the anticipation of a negative outcome in the future. For instance, the root of the fear of jumping across a stream is the anticipation of not succeeding and falling in the stream. A woman abused by an alcoholic husband is afraid of him in anticipation of anger or violence. Anxiety on the other hand, is the maladaptive response of non-existing, imaginary or mental emotional threats projected in the future. For instance, the state of mind that one experiences prior to giving a talk to a large audience. This anxious state is based on the fear of performance: self-consciousness and the fear of being judged and being seen by multiple eyes.
Anxiety in Modern Psychiatry
At the beginning of the twentieth century, modern psychiatry was influenced by Sigmund Freud’s psychoanalytic theories of the unconscious and stages of personality development. By the middle of the century, acetylcholine, norepinephrine, GABA and serotonin neurotransmitters were discovered and the psychotherapeutic approach was mostly replaced by the biochemical approach that still prevails today. Psychiatry was not the healing of the soul as it is meant by the etiology of the word, but it became a discipline dominated and constructed by the pharmaceutical industry. For example, in 2013, pharmaceutical company funds contributed more than $1.7 million to the annual conference of the American Psychiatric Association¹. From the mid-twentieth century on, mental illness became categorized and classified, requiring a diagnostic approach for the sake of attribution of specific drug treatments. For example, a bipolar disorder is treated with lithium, depression with Valium and anxiety with benzodiazepines and anti-depressants. The Diagnostic and Statistical Manual of Mental Disorders (DSM 5) became the main reference for psychologists and psychiatrists for diagnosis and treatment.
Today, the current state of the art treatment for mental disorders consists of manipulating neurotransmitters, so that the unpleasant or socially disturbing feelings do not have to be experienced.
This perspective raises a lot of questions for a responsible practitioner:
- Does elimination of unpleasant feelings solve the problem?
- Is the biochemical imbalance the cause of mental illness or is it a symptom?
- What about the social and personal aspects of human lives?
- What is (are) the cause (s) of mental illness?
- Are benzodiazepines safe, considering the serious side effects of benzodiazepines?
- Are GABA and serotonin the only neurotransmitters involved in anxiety?
Anxiety in Conventional Psychiatry
The treatment of choice for anxiety consists of benzodiazepines and Selective Serotonin Reuptake Inhibitors (SSRIs). Benzodiazepines stimulate the activity of GABA and SSRIs increase serotonin, two inhibitory neurotransmitters. The first benzodiazepine on the market was Valium but now there are 15 different types of benzodiazepines, the most popular being Xanax and Ativan. The treatment with benzodiazepines raises several issues.
1. Benzodiazepines Have Serious Side Effects
The side effects of benzodiazepines are: decreased alertness, drowsiness, dizziness, blurred vision, headache, confusion, depression, impaired coordination, change in heart rate, trembling, weakness, memory loss, hangover effect (grogginess), nightmares and a high mortality. For more than seven years, researchers followed 34,727 people who filled prescriptions for anti-anxiety medications like Valium and Xanax, or sleep aids like Ambien, Sonata and Lunesta, comparing them with 69,418 controls that did not². After adjusting for a wide variety of factors, the researchers found that people who took the drugs had more than double the risk of death. The study appears online in British Medical Journal (BMJ).
2. Benzodiazepines Create Tolerance, Dependence and Withdrawal Issues
When tolerance to a certain dosage is attained, a higher drug dosage is needed to avoid withdrawal symptoms. To counter balance tolerance, physicians increase the dose or prescribe a more potent benzodiazepine until a legal maximum amount is reached and it is impossible to obtain more. Withdrawal symptoms are drastic and most people need medical attention to get off the drug.
3. GABA Is Not the Only Neurotransmitter Involved In Anxiety
Other hormones such as glutamate, cortisol and norepinephrine for the excitatory neurotransmitters and oxytocin for the inhibitory neurotransmitters play an important role in our experience.
- GABA and glutamate are both synthesized from glutamine. Glutamate is an excitatory neurotransmitter that in high quantities can generate ROS (reactive oxygen species) toxic to GABA, as it was found by multiple studies. Our modern culture is overstimulating and generates large quantities of ROS toxic to the brain and may contribute to generation of high levels of glutamate and low GABA. Vitamin deficiencies may also contribute to an imbalance between glutamate and GABA. In particular, pyridoxal-5-phosphate, the active form of B6, is needed to synthesize GABA.
- Cortisol, norepinephrine and the HPA axis are also involved through the stress or fight or flight response. More and more studies show that social isolation especially during adolescence leads to high cortisol levels and mental illness later on. High cortisol level is toxic to the brain and creates inflammation. Social connectedness is important for the development of the brain and mental health.
- The friendly hormone oxytocin responds to feeling connected and good by an increased secretion and a reduction of cortisol.
Anxiety In Integrative Psychiatry and Naturopathic Medicine, a Bio-Psychosocial Model
Anxiety is a multifaceted disorder that can have its roots in poor nutrition, stressful lifestyle, genetic mutation, trauma, medical condition, social and family environment or belief system.
Whole Food Nutrition Versus Processed Foods
We recognize that neurotransmitters deficiencies of nutritional origins exist in mental illness and that they need to be rectified. The value of nutrition comes from the necessity to obtain the essential amino acids, minerals and vitamin co-factors, from food to manufacture the neurotransmitters necessary. Numerous studies prove that good nutrition improves mental illness and anxiety in particular. It was found that eating a Mediterranean diet lowers mood and anxiety symptoms where as a western processed food diets promotes anxiety symptoms³. Another study done in Australia on more than a 1000 women showed that “A traditional or whole diet characterized by vegetables, fruit, whole grains, and high-quality meat and fish may help prevent mental illness — specifically, depression and anxiety. Conversely, a Western diet high in refined or processed foods and saturated fats may increase the risk of depression, new research suggests”. Medscape: “Whole [food] diet may ward off Depression and anxiety” January 15, 2010 (4).
Environmental Stress, Xenobiotics and Oxidative Stress
Reactive oxygen species (ROS) generated by heavy metals, pharmaceutical medications and chemicals from food and the environment, destroy brain cells. Studies show that there is a tight correlation between ROS production and GABA secretion. Detoxification from heavy metals, a pure diet, a peaceful environment with positive connections has shown to support the psychological process of switching from anxiety to a trustful relaxed feeling in our patients.
Sociology of Anxiety
There are environmental factors that we cannot control in our lives such as a defaulting economy but there are others that we can control. For instance, the woman who lives with an alcoholic husband can be helped to make healthy decisions to leave this situation.
A lot of anxiety is perpetrated by the media. Radio and television constantly repeat feats of crimes and death by accident or murders. It affects us although it does not happen in our community and creates a state of fear, as our brain perceives these facts as real. We can eliminate the bad news from our lives.
We can change the doom perception of the future by a positive one. For instance progress of humanity has more to do with scientific knowledge than economic performances. Focusing on the positive aspect rather than the negative aspect.
Psychology of Anxiety
The type of stress that we experience today is different from the type of stress that our brain is equipped to deal with. In the past we were stressed because a crop was destroyed by a storm, right before it was going to be harvested and that meant duress and hardship, maybe famine for the future. Right now we have plenty of food coming from all over the world at anytime but we must produce money to buy that food and the stress of finding a job in a lazy economy may be as taxing as the perspective of a famine. In the past, humans were using a barter system and living in a supportive community organized around a collective survival of the species. We are now in a default community and the individual bears more responsibility.
In pre-industrial society, time was not segmented as it is now in the cities. Schedules are very oppressive in that they do not allow the individual to let activities develop organically. If we have to take a plane we must think time in reverse. This is unnatural and creates stress that can be anxiogenic.
Modern transportation has transformed our relationship to space. We can be coming and going several times a day commuting from living space to work place. We must find peace in what is perceived by chaos by the brain and do an internal work to accept that we live the life of the mind not the life of the body. The body does not like to be transported 8 hours backward in a different space. Let the body adjust and be gentle with it. Stress management consists of organizing time so that the brain has time to adjust to rapid changes. Stress management is the art of simplifying one’s life in order to make it feel harmonious and peaceful. Stress management is the realization that quality of time and not multiple achievements is what matters. Dealing with the fear of survival is at the core of stress management.
Anxiety Due to Personal Challenge: Social Anxiety
Test or job interviews are unique situation with a value higher than normal for the future of the individual that can generate the fear of failure or fear of being judged. Public speaking, going to a party where you don’t anyone, new situations that haven’t been experienced before are challenges that may be stressful for someone who is afraid new situations and functions from habits.
History of Past Trauma and Fear of Re-Enacting It
Post-traumatic stress syndrome is part of the conditions listed by the DSM5 as an anxiety disorder. The brain of someone who was in a war or was abused goes in the stress mode automatically and the person expects the worse from the environment.
According to the anxiety center, anxiety in general and anxiety disorders are on the rise. Today anxiety is the most frequently diagnosed mental illness overthrowing depression, which was the most commonly diagnosed mental illness 20 years ago.
Anxiety statistics in US:
- 40 million people in the U.S. will experience an impairment because of an anxiety condition this year (2008)
- only 4 million will receive treatment, and of those, only 400,000 will receive proper treatment
- those who experience anxiety and stress have a very high propensity for drug abuse and addictions
Causes of Anxiety
- Brain inflammation, due to high level of cortisol, brain cancer, heavy metal toxicity, viral or bacterial infection
- Neurotransmitter imbalance, excessive glutamate and norepinephrine due to stress from the environment, family, work
- Physical illness: Heart problem such as valvular disease, hypoglycemia, or COPD
- Dysbiosis, or imbalanced gut flora due to poor diet high in sugar and saturated with processed foods
- Social instability and unrest
¹ b “The Corrupt Alliance of the Psychiatric-Pharmaceutical Industry”. Citizens Commission on Human Rights International. 2013. Retrieved 2013-04-22.
² Nicholas Bakalar (2014) “Anti-Anxiety Drugs Tied to Higher Mortality”
³ Davison & Kaplan (2012), “Nutrient intakes are correlated with overall psychiatric functioning in adults with mood disorders,” Cdn J Psychiatry, 57(2):85–92
4 Am J Psychiatry. Published online January 4, 2010.