My Anxiety Keeps Persisting Even Though It Has Been Diagnosed, Rude
written with the 'Method of Writing Content Easily With Little Anxiety'
I wrote this post using the method described by Jessica Taylor in their post A Method Of Writing Content Easily With Little Anxiety. The gist of it is
The idea is that by default a human will when reading predict what word is going to come next. Studies show that humans can predict what letter is going to come next and get pretty good entropy scores. That means that even the process of reading involves generating plausible next words.
And so it is possible to similarly do the same when writing. When writing a sequence of words, after the end there will be a feeling that some word will come next. It is unexpected and abrupt for the sentence to immediately end, so there is a feeling of continuation, that something will come after. One can while writing simply look at the space right to the right of the text that has already been written and there will be a feeling there about what word will come next.
I didn’t follow the method perfectly, got ahead of myself at times, and made some edits including adding paragraph breaks and changing the title, but it was a different experience to my usual writing, quite fun, and I’ll probably try it again.
I.
Today I have been writing a list of each thing I do, think, or feel that is triggered by my anxiety. I have an anxiety disorder diagnosed by a doctor named… something I can’t remember. She told me I have an anxiety disorder and I thought she was correct. This was in maybe 2016, but I actually don’t remember, I would have to look at an old email to tell. And why am I telling you about my diagnosis of an anxiety disorder? Because I want you to understand what I mean when I say that I can’t believe how anxious I feel every day. You would think that someone with a diagnosed anxiety disorder would find it very easy to believe how anxious they feel every day. That in fact that is exactly what someone with a diagnosed anxiety disorder should expect. But in fact, if you consider it and think through the implications, the opposite falls out. Because, if you have been diagnosed with an anxiety disorder, then you know that you have a problem. You know that a medical professional has diagnosed you with a problem. (Though, in fact, I always wondered even at the time whether this GP had simply felt bad for me and not wanted to tell me I didn’t actually have an anxiety disorder when I thought I did. She said that I had “mild to moderate” Generalised Anxiety Disorder, which I thought sounded like something someone would say if they didn’t want to simply not diagnose someone. Also she seemed like a very nice and caring person, so I thought she probably wouldn’t want to just say to a patient, “No, you’re fine.” Though of course, the very fact that I worried about this could itself be seen as a symptom of an anxiety disorder.) So anyway, as I was saying, when you have a diagnosed anxiety disorder, you know that a medical professional has diagnosed you with a disorder which has symptoms such as worrying excessively, sweaty hands (if I recall correctly), nausea, finding it hard to relax, and so on. And if you experience one of these symptoms you can think “This is a symptom of my anxiety disorder”. And so one might think you would not be surprised to experience these symptoms. However, what one would not not thinking about is the fact that when you experience these symptoms, they feel real and horrible. And so even though you may think “I have an anxiety disorder and these are symptoms”, that doesn’t really help.
Well, I should correct myself: It helps a little. It helped at first. In fact, at first the idea of this diagnosis was wonderful and a relief. “Ah, I don’t just find things hard and stressful for no reason, I don’t just feel constantly in danger because that’s just how people feel, or because I really am constantly in danger, or because I’ve fucked things up and this is my destiny, no, I feel constantly in danger because I have a specific, aknowledged, medical condition which is known and experienced by many people, and socially sanctioned as a genuine problem which is not just my own bad choices or unique defect.” And so, a relief. Also, the hope of a solution. If this is a known problem (like a bug when you submit a report about an error with a website or app and they say it’s a known problem), there’s known solutions, and I can use those solutions, and I can be fixed. However, of course, when you submit a report about an error and they say it’s a known problem, it doesn’t neccessarily mean there is a known solution. In fact, if there was a known solution they would have just implemented the solution probably and you wouldn’t even be experiencing the bug. Or, if it had to be fixed on an individual basis, perhaps they would simply tell you the solution, of implement it for you immediately. But if they say “this is a known problem”, they could just mean “thank you for letting us know, but yes we’re already aware of it and working on it but we don’t have a solution for you just yet”.
Of course, some parrallels break down between this example of finding a bug in a program you’re using, vs finding a bug in yourself. In the case of a program, all the users are probably using the same program run from the same source code. In the case of your brain however, everyone’s is of course different to everyone else’s. I once remarked to a friend, “Perhaps instead of a list of diagnosable mental disorders in the DSM, we should simply diagnose people with their own disorders specific to them as a person, as no-one has the exact same set of issues in the same forms. So you would be diagnosed with, for example ‘Jalen Disorder’.” Now of course, your medical professional still needs to be able to draw on a body of medical/psychological knowledge to treat you, so having individualised diagnoses could present a problem for that. This of course is one good reason for having a set list of diagnoses in the first place. No two people’s bipolar disorders will be exactly the same, but if they share a lot of characteristics, and, more importantly, can be treated in the same or similar ways, then it can be practical to group them all under the heading of bipolar disorder, because then the medical professionals can apply all their treatment protocols that have worked for lots of other people grouped under this bipolar disorder heading. Of course, this relies on a method of grouping that does in fact lead to this property of having similar treatment prospects. So one way of assessing the DSM would be to consider how well or badly it does its grouping, based on this criterion. And when people complain that something is not a ‘real’ disorder, perhaps it would be more useful to say instead that using it as a grouping will not be helpful.
Of course, all these ideas I’m spouting about how psychiatric conditions are just helpful ways to group people’s problems for the purposes of seeing which treatment protocols are likely to be effective, these ideas are not my own original ideas, they come mainly from a smart guy/psychiatrist named Scott Alexander (well, that’s his bloggin alias), whose posts I have shared many times on this blog. If you’d like to read more of his writing on these ideas, you can read this post or this post or this delightful post about how depression is maybe like a ball rolling into a hole in multidimensional space.
So if we gave people their own individualised diagnoses, such as “Jalen disorder”, you would lose the usefulness of having grouped people under big headings which let you choose treatment protocols based on what has worked for other people under that heading. A heading of course being something such as “Post-traumatic Stress Disorder”, or in fact “Generalized Anxiety Disorder”. If I’m the only person in the world with “Jalen disorder”, then where do we go from there? “Let’s look at what treatments have been effective in RCTs for Jalen Disorder… Oh, they don’t exist. And certainly not any meta-analyses!”
But, perhaps there is a solution, even if it is only fanciful and may not have any practical effectiveness. Perhaps we could diagnose people with individual disorders such as Jalen Disorder, but then, as medical professionals, note and analyse the similarities of this disorder to certain other large category disorders, such as Generalised Anxiety Disorder. So we could say something like, “Yes, you have a definite case of Jalen Disorder. Jalen Disorder shares certain properties with Generalised Anxiety Disorder, such as excessive worrying and feeling in danger, however of course it is not the same thing, as it doesn’t include symptoms such as sweaty hands or dry mouth. It also includes other symptoms which are not part of Generalised Anxiety Disorder at all, such as waking up early if you go to bed early, so therefore never being able to get enough sleep.” Of course, now that I write that I realise that may very well be a symptom of GAD (the acronym), but I guess you get the general idea. We could use another symptom instead, something such as the fact that often when I encounter an unexpected minor complication in a task I suddenly feel overwhelmed and like I will never be able to do it. Under our current system of non-personalised diagnoses, this might lead to something such as saying “Well perhaps you have ADHD as well, let’s find out.” And then either getting diagnosed with ADHD, or not getting diagnosed with ADHD. Which is a perfectly respectable way of doing things. However, in this new personalised diagnosis system, it would lead to saying, “And Jalen disorder also includes certain symptoms in common with ADHD.”
So, what you are probably wondering now is, but how would we then proceed with treatment, if that is the really important thing? Well, perhaps we could do something like this: Based on what features your personal disorder shares with certain other large category disorders, i.e. things in the DSM, (let’s call these large category disorders LCDs from now on, because why not), perhaps you could try elements of certain other treatments that have worked for those disorders. But of course you would always have an awareness that it may not work for you, or you may need to try a modified version of it, because you do not in fact simply have the LCD, you have Jalen/[insert your name here] Disorder, which merely has certain overlapping features with the LCD in question, and so may not have the same effects from treatment. Perhaps if we organised things this way, we would naturally approach things in a way that is more open to mistakes and inconsistencies in the way we are approaching treatment. We could more easily see the ways that a certain persons problems are not responding to treatments in the way we thought they would. We would be more willing to tailor things to this individual person and take a trial and error approach to assessing the effectiveness of different treatments, and discovering what works for this particular personalised disorder, over time. We would, in short, have a better and more experiemental approach to psychological treatment, which is simply what is needed in today’s epistemic environment, when our knowlege of and understanding of human psychology and how to change it is, to put it bluntly, pretty shit.
Perhaps in reality this approach is not too different to the existing approach, on the surface. We are still drawing connections between patients and various existing LCDs. But the very fact that we are naming their disorder as something specific to them may keep us more open to the ways in which they, and their responses to treatment, differ from the median patient for any particular LCD (large category disorder).
II.
Of course, there is a way we could take this further. Rather than diagnosing me with Jalen Disorder and then noting which overlapping features Jalen Disorder has with existing Large Category Disorders such as Generalised Anxiety Disorder, we could simply note which overlapping features Jalen Disorder has with other people’s individual personalised disorders. For example, “On examining the characteristics of Jalen Disorder, I have noted that it shares many of its day to day symptoms with those of Sylvia Madden (DOB 19 November 1989, Address 8 Princess Court Chicago IL) Disorder, Mohammed Abbas (DOB 30 June 1996, 1023 Ramzy St., Heliopolis) Disorder, and 32 other disorders I have listed here. However it’s progression over time seems to be more in line with and with Yang Shihong (DOB 6 November 1947, Fu Xue Lu 27hao Zhong Guo Zheng Fa Da Xue Zhu 2117, Shanghai) Disorder and Roman Mars (DOB 27 January 1969, No Permanent Address) Disorder, even though those last two share less of the individual symptoms with Jalen Disorder that those first 34 disorders do.
Based on these facts, and the data on the treatments and results from treatment of these various other disorders which have these similarities with Jalen Disorder, let’s try the following treatment protocol. Of course, how you respond will give us further data which we may use to find other similar disorders.”
Now, this approach is basically similar to the K-Nearest Neighbours algorithm in machine learning, in which you simply look at the most similar other cases. Would this result in a very different treatment approach to simply classifying people under LCDs? Who knows. We would have to do the experiment to find out. Of course, I am sure this idea could be developed and clarified further. Improved, even 😉. It currently seems a little confused, to say the least, but simply ‘putting an idea out there’ can lead to unexpected effects. Not that I expect any of my ideas to revolutionize the field of psychiatry, but if no one ever tried any new ideas, or put them out there, where would we be? I’ll leave the answer as an exercise to the reader.
III.
Now, how does all of this relate to what I said at the beginning of this piece: That being diagnosed with an anxiety disorder did not in fact make me less surprised by how anxious I feel every day. To be clear, it has changed the way I see my anxiety, categorising it like this, but it has not mitigated the surprise or the impact. That’s not quite true, let me be clearer than that and say exactly what I mean: When I was diagnosed with an anxiety disorder, in particular Generalized Anxiety Disorder (the least ‘in particular’ possible anxiety disorder), I did in fact feel a sense of relief, as I said earlier. Or that sense of relief may have come earlier when I first considered the possibility for myself. But the surprise now is, that as I try different things for it, it continues. That the diagnosis did not in fact lead to a solution. That I have learned a lot of things about many different approaches to treating psychological disorders, and found it interesting and fascinating, but that the things I have personally tried, which are of course very far from an exhaustive list, have not, in fact, to put it bluntly, worked. Of course, it is definitely true that I have had certain benefits from certain things I’ve done. And definitely true that certain things can make my likelihood of anxiety worse, which is really the same thing. So here we do have to say that some things work. But, what has perhaps been the surprise is that, as far as I can recall, or see from looking at my current experience, I have not done some thing which has in fact worked in the sense of geting rid of the problem. Of course, some people will tell you that that is not how mental health issues work (these people will probably not use the term ‘mental disorders’ or ‘psychiatric conditions’, which of course is fine, these are all made up terms). These people will tell you that all we can hope for is something like… Learning to live with the symptoms. Or, becoming a more developed version of ourself, such that we no longer fixate on these shortcoming and sufferings, but can rather integrate them into a fuller picture of ourselves. Or, learning to go on with life and accept these problems without letting them rule our lives. Or even simply to accept that they will never go away.
I don’t like these ideas. I want my problems, the problems which can be placed under the leading of the LCD ‘Generalised Anxiety Disorder’, as well as the various other problems which are part of Jalen Disorder and currently impair my ability to be happy, live as I want to, and achieve the things that are important to me, I want all these problems to go away. And of course that’s not easy, as anyone could tell you. But I think it should be our goal, and I think that if we give up that goal, in favour of simply accepting that this has to be the way things are and maybe we can mitigate the effects a little, then we are giving up on each other and on ourselves. Not in the sense of ‘giving up on each other’s abilities and our own abilities’, but in the sense of ‘giving up on each others’ deep flowering right to eternal and endless unlimited happiness’. Because yes, let’s say we have such a right. Why not?
Well, rights imply duties, as discussed in my earlier post with Georgia Symons, Infinite Gmail Storage Should Be A Human Right, so if we say we have a right to eternal and endless unlimited happiness, who has a duty to give that to us? Well, of course the universe itself does. And it has failed in that duty in many cases. And so, as colleagues of each other and ourselves in this great profession of being a goddamn human, we have to pick up the slack that the universe left. This is not a duty nor an obligation, but merely a cool hobby that you can pick up on the weekend and use to increase the amount of happiness in the universe.
Of course, sometimes treating our personal disorder is in fact very very hard, and we are in fact not making much progress. Some form of acceptance can be a useful treatment in itself, in these circumstances.
But if we have not yet determined this to be the case, that some measure of acceptance and ‘taking a foot of the gas’ of the car of happiness eternal and unlimited is the current best treatment for us, then can we please not assume that looking to be cured is a bad thing? I don’t want to be cured of being Jalen, I just want to be cured of the current features of this current iteration of Jalen which are fucking things up.
When we update Windows to include new patches for security vulnerabilities, we don’t say that we have “tried to make Windows no longer Windows”, or that we are “Refusing to accept what Windows is”. We simply fix a few problems, which were bound to exist, in a contingent universe. Likewise, when I want to genuinely solve the problems of Jalen Disorder, that doesn’t mean I want to make myself no longer Jalen, or that I refuse to accept who I am. Problems are bound to exist in a contingent universe, and I want them solved and gone.
Of course, it may very well be the case that I also want to make myself no longer Jalen, or that I refuse to accept who I am. But these are merely further parts of Jalen Disorder, which I would also like fixed please.
So, in order to no longer feel the anxieties and various other Jalen Disorder symptoms that I feel each day, I am requesting that all patrons of the arts and patrons of the heart provide a pure and foolproof cure to every single personalised disorder held by every single being, living or dead, past or to come, human, animal, alien, or machine, and that these cures be delivered to my desk by Friday 10am. If not, we’ll have problems1.
Of course, not all problems have to solved with a ‘cure’ done once and for all. An ongoing treatment which genuinely stops the problematic symptoms when used continuously is also adequate.