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First published in Great Britain in 2018 by Bantam Press

an imprint of Transworld Publishers

Copyright © Sarah Wilson 2018
Cover and internal design: Daniel New/Oetomo New
Cover illustration: printmyfish.com
Original cover and internal concept: Sarah Wilson
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Version 1.0 Epub ISBN 9781473555686

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1.

The first time I met His Holiness The Dalai Lama, I was invited to ask him one question. He tends to go on and on, his people told me. So one question only.

Of course I fretted. One question.

I was interviewing His Holiness for a magazine column I wrote in which I explored ways to have a better life. The column was one of my smarter orchestrations. Anxiety-related illness had planted me in a spot such that I was too sick to hold down a normal job, too broke to get the healing treatments I needed. So I confected a gig where I tested different ways to heal myself. Two birds, one stone.

I deliberated for days. How would I reduce things to The question that would provide a salve to all us Westerners seeking a more meaningful path through the fuggy, constipated, heart-sinky angst of life? The choice left my head spinning and chattering. What is it exactly that we need to know? Are we here to evolve into higher beings? Why are we so alone? Is there a grand scheme to our allotted eighty-five years?

When we meet a few weeks later, His Holiness kisses my hand and tosses his thongs aside. We sink into adjacent hotel room lounge chairs. I still don’t have my one question. So I ask the most authentically pressing thing in that exact moment:

‘How do I get my mind to shut up?’

You know, to stop the fretty chatter that makes us so nervous and unsettled and unable to grasp the ‘present moment’ at the end of yoga classes when the instructor talks about it as though it’s something you can buy off the shelf.

His Holiness giggles and blows his nose on a paper serviette, shoving it down the front of his robe like my Year 4 teacher used to. ‘There’s no use,’ he tells me. ‘Silly! Impossible to achieve! If you can do it, great. If not, big waste of time.’

‘But surely you can do it,’ I say.

I mean, is the Pope a Catholic; can the Dalai Lama still his mind?

‘Noooo. If I sit in a cave for a year on mountain, then maybe I do it. But no guarantee.’ He waves his hand. ‘Anyway, I don’t have time.’ He has better things to do, he tells me. Like teaching altruism to massive crowds around the world.

His Holiness then tells me about his recent trip to Japan, how he hits his running machine at 3am every day and all about his anger issues (yes, the Dalai Lama gets cranky!). But he says nothing further about the torturous human experience of having a fretful, frenzied mind that trips along ahead of us, just beyond our grip, driving us mad and leaving us thinking we’ve got it all terribly wrong. It was as if the subject bored him.

I leave feeling deflated and anxious. I didn’t exactly have a pearly insight for my column. But a few days later I was defending his seemingly flaccid response to my close mate Ragni and I realised what His Holiness had done.

He’d given me a response that came with a screaming, cap-lettered subtext: YOU’RE OKAY AS YOU ARE!!! He’d given me – and everyone else out there whose whirring thoughts keep them awake until 4am, trash-talking their poor souls into agitated despair – a big, fat, red-robed hug. It was perfect.

Now, a strange thing happens when you realise that some gargantuan, all-looming issue you’d been fretting over no longer needs to be fixed. You take a deep, free breath, expand a little, release your grip and get on with better things.

I suspect you might be reading these words here because you’re a fretter with a mind that goes too fast, too high, too unbridled. And, like me, you might have tried everything to fix this fretting, because fretters try really, really hard at everything. They also tend to think they need fixing.

And like me you might have wondered if there’s another way.

I’d like to say this up front. I write these very words because I’ve come to believe that you can be fretty and chattery in the head and awake at 4am and trying really hard at everything. And you can get on with having a great life.

Hey, the Dalai Lama told me so.

Actually, I’ll go a bit further. I’ve come to believe that the fretting itself can be the very thing that plonks you on the path to a great life.

2.

When God was handing out The Guidebook to Life I was on the toilet. Or hanging out nappies for Mum. I was, I believe, the only person on the planet who missed out.

The first time this realisation came crashing down on me I was fifteen, crouching in an Asian-style squat behind a curtain in a Canberra shopping mall waiting to see if I’d won the inaugural Face of Miss Gee Bees modelling competition.

A few months earlier a matronly fitting room attendant had stopped me as I flicked through her bra rack and asked if she could take a photo with her point-and-click. ‘Yeah. Okay,’ I said and half-smiled, half-frowned for the camera. I got a letter two weeks later inviting me to attend the finals being held at the mall’s centre stage. Up for grabs was a modelling contract, a Dolly magazine shoot and a bra and knickers package.

The other finalists chat and laugh as we wait for the judges’ announcement. They’re glossy and cheerleader-y and all seem to be wearing the same Best & Less stilettos and black lycra micro-dresses that they keep adjusting over their bottoms, but without bending over. Because to do so would muck up their hair-sprayed quiff-fringes, a few strands combed forward over their eyes.

I hadn’t got the Robert Palmer memo.

I’m wearing an ankle-length white poly-cotton peasant dress with beige slouch socks and worn tan Sportsgirl brogues with splits in the soles. It’s a bit Linda Kozlowski in Crocodile Dundee. A little bit Out of Africa. I’d borrowed the dress from a girl at school and I’d carefully hand-stitched the princess-line seams in a few centimetres to fit. Dad Araldited the splits in my shoes and dried them on the hot water tank overnight.

I’m feeling nervous. And, oh boy, so terribly alone.

Also, this had just happened. On my second run on the catwalk for the Saturday morning shopping crowd I’d spun in front of the judges. All eyeballs were on me.

And. Then. Time seemed to stop and the world went silent like it does just before a bushfire.

And. Then. A tightly packed wad of toilet paper dropped from under my dress and landed with a light pfft, right in front of the judges.

As an awkwardly undeveloped teen, I’d do this thing where I’d stuff tissue or toilet paper into the sides of my underpants to give me hips where I had none. I wore jeans mostly, and would stick the toilet paper in the pockets, wash them and then bake them in the sun, creating papier-mâché insta-curves. I’d also wear two – sometimes three – T-shirts at a time, rolling the sleeves up over each other, and football socks with ankle boots to bulk out my undersized frame. I was an optical illusion of womanly shape that had to be carefully, anxiously, constructed each morning.

From the back of the crowd Dad whooped, ‘You little beauuuuty!’ like he did at sports carnivals when my brothers and sister and I ran into the home straight, no matter our placing in the pack.

I scampered off behind the curtain.

Was I mortified? Ashamed? No. This wasn’t the issue. The ordeal had instead triggered a panic, an overwhelming and lonely panic of the most fundamental kind.

I was breathless and alert in the car on the way home with my second-place bra and knickers package. Entirely unanchored, dangerously adrift. In this moment I fully believed that I didn’t get it. I didn’t ‘get’ life. And everyone else on the planet did. They’d got The Guidebook. They got the missive that showed them how to interject in a jokey conversation. They got the instructions for choosing the right career path. They seemed to somehow know why we existed. Shit! Shit! How was I going to get through this thing called life?

But! One of the dear, dear things about getting older, is that it does eventually dawn on you that there is no guidebook. One day it suddenly emerges: No one bloody gets it! None of us knows what we’re doing.

Thing is, we all put a lot of effort into looking like we did get the guide, that of course we know how to do this caper called life. We put on a smile rather than tell friends we are desperately lonely. And we make loud, verbose claims at dinner parties to make everyone certain of our certainty. We’re funny like that.

3.

Stephen Fry wrote in The Fry Chronicles that behind ‘the mask of security, ease, confidence and assurance I wear (so easily that its features often lift in to a smirk that looks like complacency and smugness) [is] the real condition of anxiety, self-doubt, self-disgust and fear in which much of my life then and now is lived.’

Two things about this.

Thing 1. It’s the most incredible relief to know that we’re all wearing masks … and to see them slip on others. Oh, sweet Jesus, we’re not alone! We’re in this together! It’s not a mean-spirited schadenfreude; it’s the ultimate connection. Really it is. My beaut and brutally frank mate Rick rang and asked me one morning, ‘Darl, why exactly are you writing this book?’

‘Because I can’t help it and because I’m sick of being lonely,’ I replied. Then I quoted something I’d read that morning from philosopher Alain de Botton’s The Book of Life: ‘We must suffer alone. But we can at least hold out our arms to our similarly tortured, fractured, and above all else, anxious neighbours, as if to say, in the kindest way possible: “I know …”’

‘Good,’ Rick said and hung up.

Thing 2. When you realise there’s no guidebook, an opportunity suddenly presents itself. If no one knows what they’re doing, if there’s no ‘right’ way to do life, then we can surely choose our own way. Yes?

4.

My beautiful brother Ben recently asked me over the phone, ‘Remember that time you got stuck on the bus because of that woman’s perfume?’

Nope. But if Ben, the family elephant, said it happened, it did. Ben’s sixteen months younger than me and I realise just now that he’s been my ballast over the years with his gruff, ‘Sarah, just don’t worry about it’ sturdiness. The Mindy to my Mork.

Apparently I was so distressed by the stench from the lady sitting next to me I’d covered my face and missed several bus stops. Perfume has always made me anxious. I was six.

I’ve been anxious for a long, long time. I don’t know when or how it kicked in, but I don’t remember a time without it.

5.

I was diagnosed with childhood anxiety and insomnia at twelve, then bulimia in my late teens, then obsessive-compulsive disorder shortly thereafter, then depression and hypomania and then, in my early twenties, manic depression, or bipolar disorder as it’s now called.

I’ve seen about three dozen psychiatrists and psychotherapists and spiritual healers, generally twice a week for years at a time. I was medicated from seventeen until I was twenty-eight with anti-epileptic, anti-anxiety and anti-psychotic drugs. I’ve waded through CBT, NLP, hypnotherapy, Freudian analysis, spiritual coaching and sand play. For long, lonely slabs I’ve had to step out of the slipstream of life, missing school, dropping out of university twice, quitting jobs and unable to leave the house for up to a year at a time. Also twice.

I can now tell you it was all anxiety. All of it. Just different flavours.

But at twenty-seven I decided to go my own way. I was living in Melbourne, writing restaurant reviews and celebrity features for the Sunday paper. I also wrote a weekly opinion column. I’d write it Thursday night and had the most marvellous time, under the pump, with an outlet for my thoughts on homeless people, feminism and the reasons why men always power-walk in pairs. I’d recently split from my first boyfriend and was living with a fun artist in a South Yarra terrace that was to be demolished in coming months. We wrote on the walls, ivy grew through the kitchen, we cooked stew. And I was on a conscious mission to explore sex. I came to sex late and had only had one sexual partner. I was ready to play; it was a fun experiment and one not based on pain or compromise. Things felt aligned and touched by some rippin’ flow.

And so I broke up with the psychiatrist who was my last for a very long time. I presented her with a dot-pointed rationale of why I had to go my own way. ‘I am ready,’ I told her. ‘This is the real thing, now. Life ain’t no run-up, a dress rehearsal,’ I said. ‘I’m ready for the work. It’s just hard work, right? I can do hard work. It’s a matter of firing the f*ck up.’ She shook my hand as I left her dimly lit office overlooking Melbourne’s Albert Park. I appreciate, now, that I was probably riding a slightly manic upswing.

Six months later I had used up the last of my medications. They’d run out, one by one. And I’d simply chosen not to repeat the prescriptions.

Despite appearances, this was not a monumental fork-in-the-road-never-turn-back moment. That’s the thing with my important life moments, they always seem to emerge slowly, like a Polaroid picture. I suspect few people have instant-capture aha moments. Especially those of us ensconced in the nebulous realm of anxiety where discernible lines between normal and neurotic cease, at some point, to exist.

That said, I think my adult journey, the one I’m sharing in this book you’re holding, began as I left my psychiatrist’s office on that late autumn morning. I remember the soft light. I remember doing a fist-pump as I walked to the tram stop. I was making up my own rules for managing what everyone insisted on calling an illness and I knew I was ready to live them out. I get asked how I did this. I can only say that I chose. I made the decision and then I committed, motivated predominantly by the fact that, frankly, nothing else had worked. I’ve spoken to a lot of functioning neurotics over the years and they tell me the same. You choose. You might not even know why, but you do. You commit. Then you do the work.

Oh, yeah. Then you falter. And fuck up. And go back to the beginning.

In my mid-thirties my mania flared again. And my obsessive-compulsive disorder. I’ve wrestled with OCD since I was eleven or twelve. I have to tap things and check things, and wash my hands, to a count of three. It’s a night-time ritual only. I tap light switches and doors and bathroom taps after everyone has gone to bed and I check – to a count of three, in multiples of three – for things under my bed. As a kid I counted pretty much everything in threes – cracks, drips, turnings of my pillow to the cool side when I couldn’t sleep. I know when I’m getting worse. My counting goes from sets of threes to sets of fours and fives.

At thirty-five I was also suicidal for the second time in my life. I was unable to leave the house or to work for nine months. Everything unravelled again.

I’ve since gone back to therapists. I’ve gone back to medication. And then gone off it again. I have anxiety attacks in batches throughout the year. I keep Valium in my bathroom. Just in case.

But this journey is what I do now. I bump along, in fits and starts, on a perpetual path to finding better ways for me and my mate, Anxiety, to get around.

It’s everything I do.

As someone wrote to me on my blog a few years ago, ‘Sarah, you’re all striving, no arriving.’ Yes, and I think this is the point. I’ve written more than 1500 posts on my personal blog, and hundreds (thousands?) of agonised-over columns for eleven different magazines and newspapers over a twenty-two-year writing career in which I try out different ideas and life hacks all geared in one way or another at … what? … understanding my anxiety. It’s been a rather self-serving career trajectory.

Where do I land? Modern medicine has certainly preferred dealing with my various conditions as individual diagnoses – the bipolar, the anxiety attacks, the obsessive-compulsive disorder, the insomnia, as well as the host of autoimmune diseases I’ve developed along the way (and never shall thy psychiatrist and endocrinologist meet!). But me? I think all the diagnoses boil down to anxiety. That is, an itchy sense that things are not right, a buzzing dis-ease. Whatever doctors want to call it, the feeling is the same: it’s that gut-twisting, grip-from-behind, heart-sinky feeling that winds me in tighter spirals and makes everything go faster and with so much urgency and soon enough I’m running down a steep hill faster than my poor spinning legs can carry me.

I’m aware many doctors may disagree with this notion, and I could indeed be wrong. But I reckon it’s time we explored the idea. It’s time we had the conversation because I think many of us are feeling the itchiness of something missing from the issue.

My qualifications for writing this book, then, if this matters to you, is that I’m a committed striver. I’m strapped in. Doing the work and keen to start the conversation.

I should also point out that I don’t have an answer to … any of it. You should probably know this eleven pages in. This book doesn’t take a linear path to salvation. Nope, it meanders through a series of explorations. I take off my mask and share my not-knowing.

But, dear reader, I ask you, do you feel, in your heart of hearts, that fixing your anxiety is the answer? I ask this of anyone with the kind of low-to-medium anxious buzz we’re all feeling, as well as those of you with a diagnosed anxious condition. Because the question is equally relevant. Do you think it might be lovelier if we bundle up our uncertainty, fear, late-night over-thinking and kooky coping habits, tuck them gently under our arm, and see where they take us?

This might not sound like the most ‘grab a highlighter and mark out the wisdoms’ premise for a book. But let’s see how it goes.

6.

The Journey by Mary Oliver goes straight to it. I don’t generally like long quotes and poems in books. They clutter the flow. But please, do yourself a favour and read it in full, and absorb it, so we can all start on the right note.

Don’t you reckon?

7.

So here’s the thing. A lot of us are anxious. Many of us haven’t been diagnosed as such, or even worked out if our particular flavour of anxiety constitutes a problem. But we know we’re anxious. More anxious than we should be. When I mention I’m writing a book about anxiety, everyone (and I mean every single person) suddenly goes a little wide-eyed. Drops their tone a little. Leans in. And tells me … ‘Everyone these days seems to have it, hey.’

We’re told that globally one in thirteen people suffer an anxiety-related illness. Some studies tell us that one in six of us in the West will be afflicted with an anxiety disorder at some stage in our lives, making it the most common officially classified mental illness. For men, anxiety is even more common than depression – one in five men will experience anxiety at some point. But of course these are only the stats for those whose anxiety crosses the line to become a diagnosed disorder. There’s no accurate gauge for the number of people who are feeling the frenetic toll of modern life but somehow manage to keep on keeping on without presenting to a doctor, though Google search rates can sometimes give a real-time picture of such things. And, sure enough, searches for anxiety are up 150 per cent in the past eight years. Searches for ‘anxiety at night’ have risen nine-fold.

A growing number of conditions come under the umbrella term of anxiety, in the medical sense of the word. The latest (fifth) edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the diagnostic handbook used by mental health professionals in most Western countries, lists thirty-seven different disorders under anxiety, including social phobia, specific phobias, panic disorder, generalised anxiety disorder (pervasive and chronic worry about a variety of everyday issues), separation anxiety, obsessive-compulsive disorder (OCD) and post-traumatic stress disorder. (I should note that since 2013 the American Psychiatry Association assigned OCD its own separate category.)

Anxiety was first classified as a mental disorder in 1980 in the third edition of the DSM.

Yep, you read right: 1980.

And before then? Were none of us anxious?

For nearly three centuries – pretty much since Descartes separated our heads from our flesh and bones – the idea that our emotions could impact our physical health remained scientific taboo. In 1950 only two books had been written on the topic. Two. In the whole entire world. (Freud wrote about it eighty years ago in The Problem of Anxiety, and Søren Kierkegaard ninety years before him in The Concept of Anxiety.)

We officially became ‘stressed’ from 1950, when the term was invented by an Austrian–Canadian physician who worked tirelessly to popularise the term with a one-person campaign to get the word into dictionaries around the world. An aetiology I just love.

Several dozen more books and academic papers then appeared on the subject. In the main, though, the mind–body split persisted and anxiety was regarded as an everyday condition (we all get anxious, right?) that some of us are just too weak to handle. Women who got anxious were slapped with the hysteria diagnosis. Men self-medicated with drugs or alcohol or went into man caves. And we all got on with things.

Today there are countless theories as to the genesis of anxiety. All of them are worth understanding. Childhood trauma is one. In Sue Gerhardt’s seminal book Why Love Matters: How Affection Shapes a Baby’s Brain, it’s argued that when you grow up in conditions of emotional vulnerability (anything from extreme abuse to having a parent who was busy with other children – hello, the Anxiety of Being An Eldest Child!) this can shape how you cope emotionally for the rest of your life. British TV clinical psychologist Oliver James (author of the brilliantly titled parenting book They F*** You Up) argues that childhood trauma sees you grow up in a state of permanent ‘red alert’ which deregulates your brain chemistry. It’s firmly nurture, not nature, in his book.

Low levels of certain chemicals in the brain (namely serotonin and norepinephrine) have also been implicated. Our brains process information about what’s happening inside and outside the body via the nervous system – a network of 100 billion neurons that relay information via electro-chemical signals. Serotonin relays messages related to mood, sexual desire and function, appetite, sleep, memory, learning and social behaviour. The crude theory is that when we don’t have enough serotonin, the information doesn’t get through.

More recently, it’s been found that another neurotransmitter, anandamide (a name that comes from the Sanskrit word ananda for joy or bliss), helps our brain communicate happiness, ease and comfort. Those of us with low levels of this message emitter tend to get nervous. Or so goes the theory.

Even during the writing of this book, I’ve been exposed to fresher explainers.

Recent research has shown that anxiety is more common in people with autoimmune (AI) diseases, illnesses that occur when the immune system gets deranged and attacks different parts of the body. I have Hashimoto’s, an autoimmune disease of the thyroid, a gland in the neck that controls everything that makes you a conscious, sentient being: metabolism, breathing, heart rate, the nervous system, menstrual cycles, body temperature, cholesterol, blood sugar, mood, sleep …

No one can explain the connection between AI and anxiety, in part because the genesis of many autoimmune diseases is not known. Some suggest that the uncertainty of living with an autoimmune disease is a possible factor – simply not knowing what the hell is going on with your body would drive anyone to agitated despair.

A more promising, and compelling (to me), explanation is that AI, like other inflammatory diseases, leads to high levels of circulating cytokines which have been shown to affect how our neurotransmitters communicate. Indeed, increasing evidence links anxiety to a bunch of inflammatory diseases such as atherosclerosis, metabolic syndrome and coronary heart disease. Clinical trials have shown that adding anti-inflammatory medicines to mood medications not only improves symptoms, but also increases response rate. The fact that ‘normal’, healthy people can become temporarily anxious after an inflammatory vaccine – like typhoid – lends further credence to the hypothesis.

Possibly the most exciting work is being conducted on the link between gut health, inflammation and anxiety. As you’ve no doubt heard, we have a whole community of bacteria in our digestive tract – our microbiome – which not only plays an important role in our metabolic and immune systems, but also our nervous system. Recent research suggests that these microbes may influence emotional behaviour, pain perception and how we respond to stress.

When the balance of ‘good’ and ‘bad’ bacteria is out of whack (dysbiosis, caused by such things as poor diet, medications, antibiotics, allergens, parasites, fungal overgrowth), it can trigger a cascade of inflammatory molecular reactions that feed back to the central nervous system, causing inflammation in the brain. And it’s this inflammation that messes with our neurotransmitters, leading to anxiety. Put simply, if you have fire in the gut, you have fire in the brain.

Researchers have found that folk who eat more fermented foods (which contain gut healing probiotics) have fewer symptoms of social anxiety. Another study found that eating a mere yoghurt (I say ‘mere’ because the commercial stuff contains only small amounts of the beneficial bacteria touted on the front of the tub) twice a day for a few weeks changed the makeup of the subjects’ gut microbes, and this led to the production of compounds that modified brain chemistry.

In the final weeks of writing the first draft of this book, I found out that I have a number of genetic issues that likely played a part in my anxious history. I have a defective MTHFR gene, which can affect serotonin availability and uptake. It’s a new area in the debate, so I’m still learning about its implications. My hormone clinician, Leah, suspects that I was also born with an inability to produce enough glutathione, a key antioxidant that helps eliminate heavy metals from the body. As a result, I have mercury levels that are literally off the scale (as in, beyond the graph that the labs provided). High levels of mercury, of course, are directly linked to anxiety. ‘Mad hatters’ went nutty from the mercury used in felting work. Leah reckons these genetic variables may have been ‘switched on’ by epigenetic factors such as stress, illness and environmental pollutants.

Nascent research published in Nature Neuroscience also hypothesises that phobias (an anxious manifestation, as per the DSM) may be genetic ‘memories’ passed down from our ancestors and mediated by epigenetics, which may help to explain why people suffer from seemingly irrational phobias that probably made sense at some point in our evolution (like fear of germs).

But none of the above factors consigns a person to an anxious diagnosis. You can have all of the above and never have an anxious day in your life.

8.

You know what else happened in 1980, just prior to anxiety being formally recognised and diagnosed? The first anti-anxiety drugs were manufactured. Which begs, was anxiety ‘invented’ in 1980 to fit the drug? Just a question, just a question, people …

Oh, and there’s this.

In 1994, as Scott Stossel notes in My Age of Anxiety, the term ‘social anxiety disorder’ had only appeared fifty times in the media. By 2000 it was part of our lexicon and studies were indicating that 10–20 million Americans were afflicted.

What might have triggered such a dramatic switch? Were we all suddenly being forced to go to more crowded parties in the late ’90s? Or to attend more group workshops involving those awkward trust exercises?

Or could it have been the widespread awareness campaign launched by the Social Anxiety Disorder Coalition (SADC) in 1999, just one year earlier? This particular campaign featured glum-looking folk accompanied by the truly awful tagline, ‘Imagine you were allergic to people’ and got blanket coverage across America, on the backs of buses and on freeway overpasses.

But sit tight! There’s more.

The SADC turns out to have been a partnership with SmithKline Beecham (which later became drug giant GlaxoSmithKline), which – hello! – had just released the world’s first pill, Paxil, approved to treat – you guessed it! – social anxiety disorder. Obsessive-compulsive disorder and bipolar disorder have similar drug-first histories.

Now, let me say very clearly. I’m not suggesting anxiety is a confection. I live it out viscerally, daily. So do the estimated 14 per cent of us whose lives are disrupted by OCD, social anxiety, post-traumatic stress and other anxiety-related illnesses.

Like David Beckham, who gets sent over the edge if things in his life aren’t in a straight line, or in pairs: ‘I’ll put my Pepsi cans in the fridge and if there’s one too many then I’ll put it in another cupboard somewhere … Everything has to be perfect.’ And Whoopi Goldberg, who avoids flying. I’m not sure why I’ve inserted these celebrity anecdotes. Perhaps just to lend colour and weight to the fact that anxiety is the sixth leading cause of disability in the world.

So yes, this stuff is real. And learning about it and carefully considering the various diagnoses and suggested causes and treatments is important. Indeed, it’s vital to the journey. But, I guess my brushwork here is broader. I’m plonking down the above factlets because they pertain to many of the quandaries every anxious person I know has had to face.

Am I really mentally ill? Disordered? Defective?

Or am I just weak of character and just not trying hard enough?

Does taking medication alter who I am? Am I less authentic for it? Is it ‘unnatural’?

And am I clinging to the ‘chemical imbalance’ theory because it absolves me of blame and the science-y-ness promises a neat fix?

Or are my neuroses fair enough given the state of the world today? Is my fear of crowds, confined spaces, financial ruin, being touched etc. a reasonable evolutionary response, albeit one that has got a little bit off kilter?

I’ve asked these questions for years. We have to, we anxious folk. The existing medical theories fail to answer them.

You ask the same? Well, you’re probably just as interested as me to learn that despite grand efforts to classify anxiety as a distinct disorder, there is no diagnostic process that actually works. No technique has been established that can determine the line in the sand where normal stress and fear becomes neurotic anxiety, or at what point your whirring thoughts can be explained as a chemical flaw in the brain instead of a character flaw (the former, of course, being far more ‘forgivable’ and, of course, ‘fixable’).

In fact, studies of the DSM’s diagnostic guidelines have found that when two different psychiatrists used the same edition of the DSM to diagnose the same patient, they get a consistent result only 32–42 per cent of the time.

Again, terribly vague. In Australia, just to confuse matters further, doctors work to both the DSM guidelines and a set of classifications set out by the World Health Organization (WHO), which are, not so conveniently, at odds with each other. To make matters worse, public hospitals work to an outmoded version of the WHO classifications when coding cases. Lost? Yeah, so are most medicos.

I think many of us when we’re young find the chemical imbalance rationale comforting. Which is fair enough. For me it provided a shelf on which I could place things for a bit until I could process them. To be told that we have an illness that is not our ‘fault’ relieves some of the doubt and uncertainty, and absolves us of the guilt we feel that we should be able to cope better. Which in itself turns down the anxiety dial.

Back in my late teens, doctors told me I had a serotonin deficiency in my noggin.

I’d moved out of home not long after my little brother was born and there was chaos all around me in the group house I shared with three older students. One of them loved to vacuum and practise guitar late at night, another self-harmed in her annexed bedroom off the kitchen (she claimed it was the yellow paint on the ceilings that caused it). I was studying law and politics. And working three jobs.

I was not sleeping and I was tapping and I was counting and I went on wild, wailing runs in the bush reservoir nearby at 4am when I couldn’t sleep.

And I’d sing Violent Femmes’ ‘Blister in the Sun’ (da doonk, da doonk) over and over.

I let out a big sigh when the psychiatrist explained my brain in easy to illustrate electrical circuitry terms. Finally, I had a tangible and apparently touch-it-with-a-scalpel reason for this mess in my head! More importantly those around me had a reason. It was hereditary, unavoidable and my parents weren’t to blame (at least not beyond the transferral of their genes).

Certainly it all seemed to be an unavoidable instance of genetic misfortune. My grandmother on Dad’s side was institutionalised for manic depression. She told me on a four-hour bus trip from Canberra to Sydney when I was about fourteen that she’d had electric shock treatment four times against her will. Dad was very young at the time and the details were always kept quiet. Mum’s mum suffered from terrible anxiety and was hospitalised when Mum was young. Again, these things weren’t discussed much and the details are sketchy.

This whole corner of the debate is likely to get a rise from some of you. Rapper and sensationalist Youtube dude Prince Ea waded into this territory recently and, boy, did he cop it in the comments section of his video from anxious thousands around the world tired of being blamed for their condition. Prince Ea said (to a motivational beat) that we are not our anxiety or depression. No, we are the sky, and anxiety and depression are but clouds that pass through us.

I see what he was getting at. I am not my sickness; I have a condition that can wander all lonely and cloud-like into view from time to time. I (the whole me) can choose to sit back and witness the clouds, let them be, let them pass. Pfft.

However, much online outrage ensued with many arguing their illness was most definitely medical and not a passing thing. ‘Would you tell someone who is diabetic, “You are not diabetic, you’re just choosing to focus on insulin and blood sugar levels.”’

Yep, once again, I see what they were getting at. For some of us, it does get to the point where the bloody clouds take over the sky. There is nothing left but black clouds. It becomes medical.

That said, since I was first presented with the ‘chemical imbalance’ explanation, it’s been found to be largely unproven and increasingly regarded as incorrect given how little we actually understand about how the brain works. I was pointed to the UK Royal College of Psychiatrist’s website recently. On the Treatments and Wellbeing page it tells us (bless them for being so frank), ‘We don’t know for certain, but we think that antidepressants work by increasing the activity of certain chemicals in our brains …’ The italics are mine. You have to roll your eyes a little, yes?

Besides, the quandary remains: is a chemical imbalance the cause, or the effect? Did my grandmothers’ anxiety instead cause a drop in her serotonin levels?

I admit I feel nervous about questioning the medical model when I’m not a doctor (although history shows that it’s often lay people who draw attention to gaps in science). I consulted a number of psychiatrists and heads of certified mental health organisations to ensure that my questioning was neither misleading nor harmful. I was told repeatedly over animated coffee chats around the country that it was not. Dr Mark Cross is a psychiatrist and board director of SANE Australia. He flags openly that modern psychiatry at times suffers from over-medicalisation and often a lack of informed consent when patients are given drugs without being given the full picture, including the fact that drugs are not curative in many instances. ‘We have not cracked the cure, yet patients are often given drugs without being told this.’ He goes as far as to say that the medical model can sometimes cause harm, which goes against the Hippocratic oath (which he took during his medical training).

And so you take all these unanswered questions and deficiencies to your shrink or to the self-help aisle or the internet.

One of the psychiatrists I saw in my early twenties, a grandfatherly man with a snow-white beard, conceded that yes, we’re talking about an inexact science here. He added this warning. ‘Be careful Sarah. You’re very seductive.’ He was effectively telling me that less wary doctors than he might be driven to abandon their treatment plan for me in the face of my robust questioning of the science. Which only fuelled my cynicism.

Ready to roll your eyes again? In 2011, the dude in charge of the DSM was asked by a journalist if the line between normal human response to threat and certifiable ‘disorder’ might not be as distinct as his didactic tome makes out. His response was – you can probably guess it – ‘I don’t know.’ In another interview he confesses that there are no biological markers for anxiety disorders.

And you might scream back, as I did when I reached this point, ‘But we’re not just talking about a bunch of cells and synapses on a screen here; this is my goddamn sense of self, the stuff that makes me, me!! Are we really doing this experiment, people?!’

So my point is this. Take on board all the theories. But given no definitive causes, diagnoses and treatments have been found yet, why not see this as an opportunity? An opportunity to define anxiety as something other than a problem or disorder that has to be fixed as such. UK Guardian columnist Oliver Burkeman, who dedicates his column inches to questioning self-help culture, asks whether our focusing so heavily on defining the problem tacitly creates the problem, namely that we’re broken and require fixing. ‘Perhaps the problem, sometimes, is the notion that there’s a problem.’

Dr Mark Cross agrees: ‘Just because you’re diagnosed with anxiety, doesn’t mean you have a problem, one that needs medication.’

So, I ask, could we go our own way? Could we play a little with not having a problem? Could we be so bold?

9.

Although, let me emphasise, pills and shrinks and behavioural therapies each have their place. For sure. So does a medical diagnosis. As I say, even just addressing the issue with an external party is invaluable. It can get you started on the journey. And, again, for those new to their anxiety – especially teens – a diagnosis can be a safe place to plant things until you have the wisdom and learning to take you into deeper understanding.

Last year, as I launched into writing this book, my insomnia bottomed out after almost a year of trying to get by while berating myself relentlessly for not coping better. Bugger the root cause of my anxiety! Bugger the vested interests of the drug giants! Bugger whether the chemicals in my brain were awry or not. I. Was. Not. Coping.

The lack of sleep night after night was causing my autoimmune disease to flare up terribly and I was struggling to function most days. I couldn’t hold a thought for longer than a few seconds, I was totally irascible and every nerve ending hurt. I was in pain – an inflamed, aching pain that I describe to those who care to know as someone running their nails down a blackboard and rubbing your nerve endings with a scrubbing brush, simultaneously. I was existing like this five or six days a week. My former business manager kept having to take me aside and explain the impact my frazzled state was having on the team in the office. Every human irritated me. Unlike in the past, when I worked on my own, I couldn’t squirrel myself away from the world, saving them from my sub-human presence. I was now highly accountable.

It was when a friend confided that she couldn’t run her fashion styling business without seeing a therapist every week that I was reminded of a sensible commitment I’d made back when I first went my own way at twenty-seven. I’d promised myself I’d get help if I needed it again. I went back for anti-anxiety tablets, which I took for ten months. And then I went back for psychoanalytic psychotherapy, an old-school style of therapy that focuses on understanding and expressing feelings, which I’d abandoned for many years in favour of the more modern cognitive treatments, which teach techniques that control said feelings.

I saw Dr H for six months before he dismissed me, finding me to have stabilised enough to venture back out on my own.

Like I say, it’s a bumpy journey.

10.

Even today, truth be told, I’m not entirely sure I have an anxiety disorder. As such. Or if I’m just terribly deficient at coping with everyday living. You too? Which leads me to point out the first of many cruel ironies in the anxious struggle. There are a few.

Let me explain.

Anxious behaviour is rewarded in our culture. Being highly strung, wound up, frenetic and soooo busy has cachet. I ask someone, ‘How are you?’ and even if they’re kicking back in a caravan park in the outback with a beer watching the sun set, their default response is, ‘Gosh, so busy, out of control, crazy times.’ And they wear it as a badge of honour.

This means that many of us deny we have a problem and keep going and going. Indeed, the more anxious we are, the more we have to convince ourselves we don’t have a problem. This is ironic, or paradoxical. And it seems awfully cruel. I read an interview with a clinical professor of psychology and psychiatry at Weill Cornell Medical College who said it takes 9–12 years for women to get a diagnosis for anxiety. I presume it would be just as long, possibly longer, for men. We suck it up when we feel anxious and soldier on until, well, we tip over the edge and our anxiety turns pathological and medical. Flipside, depressed behaviour – slovenliness, unproductiveness and suck-holey gloom – is something we abhor. Thusly, depression is an issue. And, thusly, we have lots of structures in place to identify it and treat it.

Depression is stigmatised, anxiety is sanctified as propping up modern life, which ironically sees depression treated as a legitimate illness, and the anxious left in a cesspool of self-doubt and self-flagellation for not being better at coping with life. And so we buy each other Keep Calm and Carry On mugs as though that’s something you can just do.

But it gets worse, you see. We then try to cope by revving up the angst, don’t we? We use coffee and fast-speak and sugar and staying back at work longer. We grind harder. Try harder. Think harder. We should be able to work our way through this. We think this is what will fire us up out of our funk and get us back on our game. It’s a self-perpetuating pain – we use anxiety to fight our anxiety.

But we don’t see it, often until it’s too late. I suspect many of you with anxiety who are reading this struggle to see it clearly. And struggle to treat it appropriately, with candle-lit baths and ‘me time’ and cortisol-calming medicinal foods. I do (struggle) and I often don’t (do candle-lit baths when I’m nuttily fast in the noggin).

For years I saw my life as a stacked spiral of dominoes. Until I realised a Jenga stack was probably a better metaphor. I was wholly convinced that if I removed my bull-at-a-gate approach, even just a few struts, the whole structure would topple. I was told to ‘back off’. To ‘just relax’. I dismissed such notions because they only induced further anxiety. I felt I’d be nothing without my anxious drive and when I felt it sag a bit I’d panic. I’d sturdy things again with a stern talking-to. ‘Fire up, Sarah.’ I’d rev up my adrenals with punishing runs and double-strength long blacks. I could not let this whole game fall over.

I was rewarded for doing so with better jobs and lots of admiring looks. Until a gentle zephyr happened by and knocked the whole rickety structure to the ground. (We’ll get to this in a bit.)

We also need to recognise – and many doctors don’t – our anxious behaviours are so often the solution