The Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-V) does a brilliant job, as it should, of casting a wide net with its diagnostic criteria. As with any disease (or, philosophically, any thing), we understand that the experience is not a monolith. Rather, everyone who experiences the same condition will experience symptoms within a spectrum rather than according to a rigid template.
Within the scope of mental health issues it comes as no surprise that any two individuals dealing with disorders of any type will find some measure of experience similar. My experience with social anxiety disorder has at least some similarity with anorexia nervosa, for example. The symptoms may be completely different, but I might bond with them over the social stigmatisation of mental health.
Contrariwise, it’s also true that two individuals with the exact same diagnosis will have different experiences. One may be more mild. One may exist for a longer term punctuated by acute episodes while another may be the same, constant level.
What we do not seem to discuss often is how the experience within the individual changes over time.
My various anxiety diagnoses appeared over the first two decades of my life primarily as an upset stomach and general unease. To this day my parents occasionally apologise for not taking my symptoms more seriously, though I cannot blame them because who would have thought my inconvenient stomach aches anything more than that?
My only concern as a child was that they thought I was faking the stomach ache altogether, not that they missed a more serious diagnosis. The stomach aches would appear at times that seemed suspicious to them: as it was time to leave for school, as it was time to visit a doctor. Any time I might want to get out of something – stomach ache. What none of us put together was that it was a manifestation of my anxiety about the situation rather than a purely psychosomatic response.
Yes, we’re splitting hairs because it’s still a somatic response to a psychological trigger.
It was not until my twenties that things took a turn. I would continue to struggle with stomach issues (still not realising they had a connection with anxiety), but I developed the added pain of trembling and light-headedness.
While on a family trip to see my brother in Boston, we passed through a waterfront pavilion where I was overcome with an intense feeling that something was wrong. Breathing felt difficult, my legs felt unable to support my weight, and my hands began trembling. Even worse, the feeling did not simply exist – it intensified until we escaped to the nearby park. While the episode subsided in the open air, I remained shaken the rest of the day.
Episodes like that became more common until one day, just laying in my bed, the feeling became so intense that I found myself thinking, “I need to get away from this.” The “this” in my mind was living. It was not a suicidal ideation as I now understand the concept. There were no plans for how I might go about killing myself and the thought of suicide scared me into therapy.
These were not suicidal thoughts, but at the time I worried that they might be. Literally, “Is this what suicidal people think?”
My interest was not suicide but in removing myself from life temporarily to some other plane of existence as a respite from the generalised anxiety I was feeling. Once settled I would want to return to my life – nothing as permanent as death. Rather than trying to end it I was trying to step outside the pavilion to the park for some air, as I had in Boston. The pavilion now happened to be life.
It frightened me enough to compel me to therapy where I did begin making gains against my anxiety (and learned about my personality disorder in addition to the anxieties). Several severe panic attacks later I would begin a medication regimen to help control the somatic symptoms, but I immediately began learning coping tools to manage the anxiety myself: breathing, meditation, etc.
This is where I find mental health recovery can be tricky though. I had such a clear sense of my own anxiety at this point that I made fast gains in recovery. For one thing, I learned that I carried a lot of my anxiety in my jaw, clenching hard in the face of anxiety. That physical act triggered many of the somatic symptoms I experienced (such as the light-headedness) that made panic attacks intense. By learning to focus on unclenching my jaw alone, I alleviated many of the somatic symptoms and was able to focus more on my thoughts.
As Ian Malcolm of Jurassic Park fame once said, “Life finds a way.”
Full management of my anxiety not yet attained, it had to find new outlets for itself. While I had learned to plug the leak in one area, I had not learned to relieve the overall pressure and so leaks would begin to spring elsewhere.
After months without a panic attack or any particular feelings of stress or anxiety, my vision suddenly failed. I thought the weird lighting in my parents’ living room had inadvertently dilated one pupil but not the other (have you ever looked at your phone in the dark with just one eye and then tried to look elsewhere with both? They are not adjusted the same).
I found a nearby label and began to administer a non-scientific eye exam. Both eyes were able to read, but my left eye was seeing things with a darker tint (which I had misinterpreted as my right eye getting too much light) and somewhat out of focus. My right eye retained its hawkish vision.
Central serous retinopathy. Fluid leaked between my retina and optic nerve so I am literally looking at the world through a sort of gelatinous bubble. It’s not painful and nothing dangerous – in most cases it resolves spontaneously with no treatment, and the treatments that do exist are mild.
What is interesting about it is the cause. The condition is what the medical community still considers idiopathic, but all signs point to steroids. In some cases the steroids are manually introduced, such as through topical creams to treat other conditions. In other cases the cause is corticosteroids produced naturally in response to stress (what the ophthalmologist referred to as Type A personalities – though even he admitted the phrasing with outdated).
In a more embarrassing note, I developed a mild problem with haemorrhoids. I thought little of this as well because the problem was extremely mild – I barely noticed it was happening. It’s also worth noting that I do not drink enough water, do not take in enough fibre (anxiety already gives me stomach issues), and spend all day sitting for work. Made sense that I might occasionally have an issue.
Turns out the cause here again was stress. More specifically, the stress correlated with the anxiety that I managed with medication and just the right tools to address the symptoms I recognised. Anxiety 3.0 was not using the same playbook as anxiety 2.0 though.
While I managed mild conditions falsely attributed to “getting older,” the anxiety wreaked havoc on my body adding more and more stress until, as I lovingly joked with my wife, “my eye and my asshole are trying to eject themselves from my body.”
One must be mindful that how mental illness looks will differ not only from one individual to another, but also possibly within one individual from one time to another.