Thursday, 31 July 2014

On Anxiety and its Disorders: A Reconceptualization

Patrick Allen
This post summarises the research focus of Patrick Allen, PhD student at the University of Birmingham Philosophy Department, currently supervised by Lisa Bortolotti and soon also by Hanna Pickard.

My research is concerned with investigating and unpacking the premises underlying the psychiatric conceptions of so-called ‘anxiety disorders’. My research begins by assessing the historical trajectory for how we have come to think of anxiety as a psychopathology or a psychiatric disorder that may or may not require psychiatric (medical) attention. By considering how we have come to think collectively of anxiety as a psychiatric disorder (when it could be argued to the contrary), this leads to philosophical problems concerning the validity of the conclusion that anxiety is in fact a psychiatric disorder. To assess validity, I contrast historical turning points, evolutionary theory, usages of language and meaning, and plausible explanations that are in contrast and contradiction to the contemporary psychiatric conception of anxiety as a psychiatric disorder.

Predicated on my conclusions surrounding the validity of considering anxiety as a disorder, I then argue the ethical ramifications of diagnosis and treatment. If it is plausible to state that anxiety as a disorder is not a valid or sound conclusion, then it stands to reason that the method in which psychiatry has developed a system of diagnosis and treatment for anxiety requires an ethical evaluation. In this I pose the question, “could personal autonomy be undermined by the medicalization of anxiety and psychiatric influence?” This part of my philosophical investigation looks at the sheer number of reported cases in recent times of so-called anxiety disorders and the widespread usage of psychopharmaceuticals and other treatments aimed at solving this suggested medical disorder.

Embedded in my ethical argumentation are also assessments of whether or not treatments such as psychiatric drugs or talk therapies aimed at reducing anxiety are not best considered treatments but instead, ‘enhancements.’ My arguments surrounding enhancements envelop problems in social knowledge and ideas of ‘medicalization’ that argue – ‘while people do experience anxiety, it is perhaps our collective perception of what ought to be treated by medicine or what we are influenced to believe are medical problems rather that what ought to be considered something that is simply ‘normal’ and something that could be considered beneficial or adaptive and non-medical. In conclusion to my assessment of whether or not treatments are in fact best-considered treatments and not enhancements, I then consider what are thought of as non-medical or unconventional approaches to anxiety reduction such as talk therapies and concepts for anxiety in Eastern Philosophy such as Buddhism and the concept of ‘dukkha’, which means ‘suffering’, ‘anxiety’ or ‘stress’.

Finally, I attempt to complete the puzzle as I then offer suggestions and solutions as to how anxiety might be re-conceptualized to offer better outcomes and a broader perspective and understanding on the nature and experience of anxiety and what we ought to do or not do when we experience it.


  1. I'm really interested in this subject. Although I don't know exactly where you are going with this (perhaps you don't either yet - if your PhD is anything like mine) I suspect we are in broad agreement about over-medicalisation of psychological experience. Some of what I do with clients who are worried about their anxiety relates to normalising the experience. For example, if someone is doing something they have never done before which involves any kind of risk they are SUPPOSED to feel anxious - this is simply an indicator that they need to plan what they are doing and take extra care. If they do this the anxiety often diminishes or falls away completely (or perhaps they conclude that they simply do not want to take the risk involved and seek a different course of action). When a client thinks that their anxiety is an illness this stops them from looking at the reality of the situation and what they need to do - they think they should be able to take a pill and the feeling will go away. I come across this regularly in my counselling practice - and, in my experience, it seems to be an increasing trend in younger people. The increased medicalisation of anxiety seems to lead to family members ignoring real concerns (for example the need for parents to help their children in practical ways to understand what they need to do when they go away to university) and instead results in sending them to the doctor for medication. In general worrying about being 'ill' (when you are actually reacting in a perfectly normal way) simply increases the anxiety. Maybe 'anxiety disorder' is often iatrogenic.....

  2. Thanks for your very thoughtful comments Rachel. I agree with you, and in fact, in my work I argue that it is the case that calling anxiety a disorder and medicalizing it is a large part of the problem (leads to iatrogenesis). In North America (where I reside) when people speak of anxiety or other psychological issues, it is usually tailed with what drug(s) they are using to curtail or even 'cure' the 'imbalance' or 'disorder'. This narrative, I believe, is the result of marketing and manipulation by drug manufacturers, and to some extent: the medical establishment. It becomes hugely convoluted when you start to dig down to the roots of the matter, but the massive spike in anxiety as a medical condition seemed to start and escalate in the last sixty years with the publishing of the DSM and the discovery of psychopharmacology. Indeed, the trend to diagnose anxiety as a medical disorder and to medicate it has not subsided, but instead grown substantially.

    There is also a troubling narrative that is also pervasive in psychiatric language and now found in common language that has influenced the belief that if you have anxiety then you must be in some way sick and require a medical intervention. I believe use of language is a large part of how anxiety has come to be medicalized. In fact, I think it is especially true with anxiety because people who are anxious will do anything to make it subside. This then makes it easier to influence people or to insert a narrative to satiate the uncertainty associated with anxiety. As a society we now look upon medicine to answer our questions, then the process of medicalization begins with a story that seems veracious but instead leads people into believing that they have chemical imbalances or psychiatric disorders and not just ‘normal’ anxiety.

    The problem with all of this is that there are very strong arguments that suggest that anxiety is not and should not be considered a mental disorder and is instead a necessary mechanism to ensure our survival. These counterarguments to the claim that anxiety is a medical problem become very compelling when you consider the history of how society has arrived to consider anxiety as a series of medical disorders and to endeavor to 'fix' it with psychopharmacology.

    In particular I also like your comment about worrying about worrying and iatrogenesis. Recently I started reading about 'Cyberchondria'. With Cyberchondria, a person might have anxiety then decide to 'Google it' and self-diagnose and to find a ‘cure’ for the way they feel. This then results in more worry and more anxiety about being anxious in the first place. This can then lead to a negative feedback loop that makes the person much worse off than if they did not try to ‘learn’ about their condition. I think that this is a result of the way we are trained to think; that if something bothers us or we do not feel good, then we ought to seek out a cause and find a specific name or diagnosis for it so we can then exact a solution or 'cure'. The problem with anxiety is that this kind of approach just leads to more anxiety and is counterproductive. So in the case of anxiety leading to more anxiety, I argue it is the case that the narrative, language used in the narrative, and social beliefs all play a part in the iatrogenesis of anxiety. It might be best if we disassociated anxiety with medicine and re-conceptualized it…we shall see, in the next two years I plan to make a case for this ;)

    Thanks again for your wonderful comments!

  3. Patrick you really did splendid research and I like it. I studied a lot on Anxiety Disorders and finally come up with. Try out deep breathing to alleviate heavy breathing during anxiety attacks. Deep breathing will also prevent hyperventilation. You will find that your anxiety eases as you breathe deeply, watching your stomach rise and fall with each breath.