Anxiety: A Love Story (an open letter to colleagues)
How did anxiety get such a bad rap? This harmless feeling is widely feared, and has been pathologized by the DSM as a ‘disorder’. Well-meaning PCPs regularly write prescriptions to help their patients banish it. As mindfulness-oriented clinicians, we may find ourselves, oddly, as ambassadors of anxiety.
Abraham Lincoln famously described de-fanging his enemies by making them his friends. How Mindfulness is that? He understood the power of shifting out of struggle and into a new relationship with difficulties.
How can we help our clients to love, or at least befriend, the feeling they fear? For some of our clients, it may begin with entertaining a simple thought like “Maybe the way I’ve been thinking about anxiety isn’t helpful.” Awakening, for some, may simply be coming to see that there is another way to relate to their experience.
Years ago I quietly dropped the word ‘disorder’ when discussing anxiety with clients. Instead, I encourage them to consider it as a universal human feeling- not always a sign that something’s wrong. (Similarly, I encourage clients to refer to acute anxiety as ‘panic feelings’ rather than a ‘panic attack’. There is no attack- that word is an inflammatory embellishment.)
How we think about feelings matters- and our thoughts about them often cause more distress than the feelings themselves. But this view requires a flexibility of mind that stretches many of our clients, especially those conditioned by perspectives, including much therapy, that assume anxiety is a problem and the goal of treatment is eradicating it.
In Tibetan Buddhism there is a teaching called “Too close, too easy, too vast, too wondrous.” It means that the idea that vast and wondrous changes could come from a small shift in perspective or thinking seems “too easy” from the conventional view.
Perhaps then one of our main challenges is helping clients deal with how relatively simple mindfulness is. Maybe we should make it more complicated. The western cultural influence that teaches us to roll up our sleeves and attack the problem can be a central hindrance. The nuance of the method- that relief comes in letting go, of reducing the struggle with experience, is counterintuitive, and countercultural.
Often a key piece of treatment is helping clients direct their work ethic in a productive way. From struggling with anxiety, or trying to make something happen in meditation, we may shift to actively strengthening what one of my teachers calls the love muscle: Actively nurturing kindness, patience and compassion. It’s something the client can ‘do’. From offering passersby a silent wish (“May you be happy.”) to bringing a half smile to an anxious feeling, we begin to cultivate more constructive doing, without struggling.
Similarly,we may help clients proactively create new narratives about feelings. One I often offer is from Thich Nhat Hanh, who writes that our feelings are our children, and we must hold them with tenderness.
In the complex relationship to our feelings, awakening starts with seeing that there is in fact a relationship there- a pattern of responding when feelings arise. From awareness, mindfulness, acceptance and perhaps other steps along the way, we may ultimately arrive at love. Sometimes perhaps all that’s missing is someone in a position of authority- like a therapist- to endorse, with a sprinkle of formal diagnostic language, the efficacy of love.
The other night, drifting off to sleep in a playful reverie, I imagined a future time when Mindfulness-oriented clinicians had further claimed their collective voice and published a Mindfulness Diagnostic Manual.
I imagined a client telling a loved one about our first meeting.
“Oh dear, I’ve been diagnosed with a Flabby Love Muscle.”