Reflections

Overall, this project taught me how to better understand generalized anxiety disorder considering the context of its medicalized history and how it is represented within the media. During my research, I found that there was much more that has yet to be thoroughly researched about the disorder. Why does it appear in mostly women? Why is it a “white” condition? Has it been implicated with colonialism at all? How does it manifest across nations outside of the U.S.? I hope for this project to not be the end of my education on this subject as I continue my own struggle with my mental and physical well-being. Well I remain unsure of whether to categorize my anxiety as mere stress or something worth being medicalized, this project has encouraged me to take these feelings and thoughts seriously as I move forward in my life.

What Can Be Done?

           In order to address generalized anxiety disorder to the fullest extent, our understanding of health and mental health must be uprooted. Currently, health is understood as something that exists in a vacuum and is mostly affected by germs and microbes in our environment. We can stay healthy by washing our hands, eating well, and exercising. We are also encouraged to go to the doctor regularly to ensure that we are in good health. However, in many ways mental health cannot be understood in this way. Mental health disorders are not “caught” through germs; they manifest and are triggered with age. As long as there are stigmas attached to mental health disorders, individuals will feel uncomfortable going into therapy and receiving treatment. On the flipside of this, as long as any emotions and worries outside of society’s defined norm are considered disorders, then individuals’ problems will continue to be medicalized regardless if it is warranted.

            A solution I’ve seen enacted right here on campus is within the Tang Center’s “Do you!” campaign around things such as dating, drinking, and sex. This campaign encourages individuals to decisions for themselves according to their own needs. I’ve also seen it manifest in safe spaces at events as a means to encourage individuals to do whatever makes them feel comfortable in that space. This year at a panel for ASUC elections hosted by GenEq, the introduction encouraged everyone present that it was okay to leave the room if you felt uncomfortable and that it was important that you did what was necessary for you to feel safe and healthy in that space. A move towards inclusive spaces like this would be highly beneficial to those with varying degrees of mental health. As society removes the stigmas attached to panic attacks and other reactions associated with anxiety, hopefully those grappling with these conditions can feel more included and able to venture into unknown spaces.

            There are still issues with symptoms of anxiety being seen as illegitimate or irrational. If more people were educated and understanding of the sensitivity some individuals exhibit to certain experiences, individuals with anxiety would feel comfortable expressing these fears. One of the best tools we can use for this is education. As I’ve learned throughout the semester in my disability studies class, simply engaging with differently abled individuals can be a crucial learning experience. I can only hope that as time goes on our society will become more inclusive and understanding of those with mental conditions.

Images of GAD

Images of GAD

            Generalized anxiety disorder is a unique case in that it is racialized as white and gendered as female. Woodman has discovered in reports that “prevalence was lowest in the youngest age group and increased with age: The prevalence in women aged 45 and older was 3.5% for those with current GAD and 10.3% for lifetime occurrence of GAD” (Woodman 3). Researchers also “found that homemakers and unemployed respondents (mostly permanently disabled individuals and early retirees) had a significantly higher prevalence of GAD than other subjects.” (Woodman 3). Since I am unable to find information that explains why this disorder has been prevalent in white, unemployed, older females, I will look to images that depict GAD and attempt to theorize why this disorder is prevalent in this group.

            After completing a search on google images, I found that the majority of people depicted with anxiety were white women. A few results were men, and nearly every single person was white.

(http://www.uncanxietyclinic.com/wp-content/uploads/2012/11/Psychoanalytic-approach-to-generalized-anxiety-disorder.jpg)

(http://www.natural-holistic-health.com/wp-content/uploads/HLIC/5eabfb2483dc42cd5415f8a0f55c6c73.jpg)
            What do images say to people who may feel like they have a certain disorder but are unsure? These images demonstrate that anxiety is a white woman’s problem. For men and people of color, excessive worry is not within the realm of medicalization and can be tackled presumably through other means. These images can be both helpful and harmful as white women’s worry is legitimized through medicalization.

Generalized Anxiety Disorder in the Media

GAD in the Media

            Much of our understanding of diseases and disorders can come from media depictions of it. When we don’t personally know someone with a certain disorder, it is difficult to get an accurate representation of how it manifests in people’s lived experiences. For this section, I will analyze the two depictions of generalized anxiety disorder that I have seen in the media. The first is featured in the E! reality series “Married To Jonas”. The second was in Michael C. Hall’s character on “Six Feet Under”. These depictions are also of interest due to the ways they were implicated by gender and sexual orientation.

            I normally would not watch a series about Jonas Brothers’ married life, but I was very sick one day on the couch and managed to catch a marathon of it. The series follows Kevin Jonas and his wife Danielle Jonas as he navigates jumpstarting his career as well as his family. Danielle Jonas happens to have generalized anxiety disorder and struggles with it throughout the show. At first, she is uncomfortable telling her husband that she is having severe anxiety and panic attacks again after being in a car accident. She asserts that “I try to be strong for Kevin,” but sometimes my body shuts down” (Larrabee). Originally, I was very surprised that she wouldn’t share this key factor of her health with her husband.

            As the show went on, it became clear why she did not feel comfortable sharing this information with her husband. Kevin Jonas was set upon starting a family and did not want his wife getting pregnant while on her anxiety medication. He has his life plans set up: get his wife pregnant, go on tour, come back and raise his family. Danielle’s disorder is disrupting that for him. Instead of being supportive and encouraging her to do what’s best for her health, he makes her feel disappointed in herself that she cannot have his child yet (Larrabee). To solve this, Kevin Jonas decided to whisk her away on a trip to Italy to get her to relax. She set a goal before the trip to get off her medication so she can get pregnant. When she was unable to get rid of her anxiety over the course of one trip, she was “completely overwhelmed and felt like a failure” (Larrabee).

            Nearly everything about the depiction of Dani Jonas’ anxiety was implicated by her gender and status as Kevin Jonas’ wife. Kevin wasn’t interested in her health for the sake of her own well-being; he was only interested in her reproductive capacity. Dani was depicted as unable to keep it together for her family and for her husband, though certainly not for a lack of trying. Her health was only of interest to the extent that it affected her abilities to produce children for her husband. This was particularly troubling and demonstrated that we still have a long way to go to understanding women’s health outside of their reproductive capacity.

            The second depiction I’ve seen of anxiety was on “Six Feet Under” with the character of David Fisher, played by Michael C. Hall. The show features a few main characters that have various mental disorders including bipolar and psychotic depression. David Fisher is “healthy” throughout the series until he picks up a hitchhiker who he finds attractive. He seems innocent enough at first, until he begins to ask David for money and holds him captive. All other storylines are halted in this episode David is forced to smoke crack, is doused in gasoline, then has a gun shoved in his mouth to symbolize fellatio (“That’s My Dog”). His torturer eventually leaves him and David makes it out alive, but not “well”.

            After this incident, David is seen experiencing symptoms of post-traumatic stress disorder as well as GAD. He finds himself easily triggered in many situations and fearful that he will see his attacker again. He has panic attacks and is unable to continue his work at the funeral home. At the end of the season, he confronts his attacker in jail and has a poignant conversation with his dead father who insists that “You can do anything, you lucky bastard - you're alive! What's a little pain compared to that?” (“Untitled”). However, this is not the end of David’s struggle with anxiety as he adopts children and fears for their safety and continues to be triggered by certain events. One of the most heart wrenching moments occurs near the end of the series, when David is nearly unable to attend his brother’s funeral due to his anxiety (“All Alone”). However, this storyline was not without controversy as fans were concerned that David’s character was being punished for his sexuality (Nussbaum). The creators and writers stand by their story though, insisting that “I’m gay, Alan Ball is gay; homophobic is the one thing you don’t get off calling the show” (Nussbaum). While this is certainly not true, I’m inclined to see the storyline as another extension of the trauma that many of the characters faced throughout the series.

References

Buck, Scott. "That's My Dog." Six Feet Under. 18 July 2004. Television.

Larrabee, Dory. "‘Married To Jonas’ Recap — Danielle: ‘My Heart Is Literally Broken’."Hollywood Life. N.p., n.d. Web. 01 May 2013.

Nussbaum, Emily. "Captive Audience." NYMag.com. N.p., n.d. Web. 01 May 2013.

Oliver, Nancy. "Untitled." Six Feet Under. 12 September 2004. Television.

Robin, Kate. "All Alone." Six Feet Under. 5 August 2005. Television.

Mid-Project Reflection

            Somewhat ironically, as I complete this project I find myself having more anxiety than ever in my day to day life. I made the unfortunate decision to take 20 units this semester, plus continue working and volunteering with various organizations on campus. When I found the workload to be too much, it was already too late. I’ve found myself experiencing new forms of stress and worry that I hadn’t before. While it is about things “worth” stressing about, such as papers and finding housing, it is much more intense and draining than any kind of worry I have experienced before. I find myself too overwhelmed to complete some of the most basic tasks. Luckily, I snap out of it within a few hours but end up “wasting” those hours in the meantime. It got bad enough to a point that I did call the Tang Center to schedule a free counseling appointment. I called and they scheduled me for my phone consultation, which was already difficult to squeeze into my busy schedule. When it came time for my phone consultation there was no one available and I had to leave a message. By the time they got back to me, my schedule was far too booked to continue with a phone call plus appointment. While these experiences have certainly not helped this semester, I am learning to cope and question why I feel the way I do. I plan on going in for counseling once finals are over to work on getting things sorted out.

Implications of Biopower & Treatment

                                               Implications of Biopower & Treatment

            Stemming from the effects of biomedicalization is the placement of treatment in the realm of the individual. While this may seem empowering on its face, individuals are considered responsible for their health regardless if they have access to the resources necessary to treat themselves. This is also further implicated with challenges when mental health is involved since individuals may not even be diagnosed with whatever condition they’re supposed to be treating. The symptoms of generalized anxiety disorder are easy to gloss over in our culture as the fault of individuals. Looking to my mother’s experience with this disorder, many have told her to “just stop worrying”. A more dynamic understanding of this disorder is needed as we look deeper into the societal pressures that may affect it.

            The emphasis placed upon the individual to treat GAD through things like self-help books is highly reflective of Foucault’s concepts of biopower. Johnson notes how within biopower, “one of the ways in which individuals are induced to embrace and activate power over their own lives is in the name of health” (Johnson). Within Foucault’s studies of surveillance, he was particularly interested in the ways that individuals were observed in hospitals. He “wanted to find out how the medical gaze was institutionalized, how it was effectively inscribed in social space, how the new form of the hospital was at once the effect and the support of a new type of gaze” (Foucault R138). He analyzes the manifestation of biopower as contrary to history’s interests in controlling who dies. He analyzes how within Western history, there was a shift from controlling who could live to how they could live. It is a form of power that is productive and forces life to appear in certain ways. It is important to note that it is not something to be wielded by certain individuals or groups and is not orchestrated by anyone in particular, but rather permeates how our society functions.

            Under a lens of biopower, GAD can be seen as a disorder in need of treatment in order to produce individuals of a certain type that has been defined as “normal” by society. These individuals are supposed to worry less and consequently be more productive and valuable within our neoliberal capitalist society. Individuals today are likely to search for treatment options first on the internet. WebMD is one of these popular online resources that many can use to diagnose themselves with certain conditions. Under their home treatment section for anxiety, WebMD recommends recognizing your anxiety by dealing with it, practicing relaxation techniques, and by exercising and eating well (“Anxiety & Panic Disorders Health Centers”). These are all activities that individuals can be expected to do in order to maintain their health. As we see in Lauren Berlant’s piece, these things are not always in reach for everyone. There are those who are unable to find a safe place to run or go for a walk. Under the models of biomedicalization and biopower, individuals must take these basic strides for their health or else some blame is fairly placed upon them for their mental health status. When people possibly do not have the time or resources to care for themselves, society now has more leverage in placing the blame of the condition on the individual.

            First steps towards treating GAD also include self-help books and guides which are widely available to American consumers. These books are “linked to American ideals of self-mastery and self-invention, and they typically aim to inspire and instruct their readers by providing wisdom and encouragement” (Johnson). The discourses contained within these books “accomplish two vital functions of biopower: first, all of life is rendered in calculable, scientific form and second, individuals are interpellated as active agents who can act to improve their health through techniques of self-government and self-management.” (Johnson). While these books may be useful resources for those interested, pressure is placed upon individuals to use these books whether they want to or not. People of various states of mental health are expected to seek out these resources in order to regulate their lives accordingly.

Resources

"Anxiety & Panic Disorders Health Center." WebMD. N.p., n.d. Web. 02 May 2013.

Foucault, Michel. “The Eye of Power” (in reader).

Johnson, Davi. "“How Do You Know Unless You Look?”: Brain Imaging, Biopower And Practical Neuroscience." Journal Of Medical Humanities 29.3 (2008): 147-161. Academic Search Complete. Web. 2 May 2013.

Medicalization

Medicalization

            In order for a condition, disorder, disease, or any other social “ill” to be recognized by the medical community, it must go through a process of medicalization. This process varies by the disease and by the historical moment that it is situated in. Medicalization has been defined as “the processes through which aspects of life previously outside the jurisdiction of medicine come to be construed as medical problems” (Clarke, Fishman, Fosket, Mamo, Shim R169). These processes occur when doctors and researchers come to see the problem in question as something that could be solved by medicine.

            In order to understand the medicalizing process of generalized anxiety disorder, we must look to its history, which has unfortunately has been difficult to track. Woodman notes that “The relative mildness of the symptoms and the high rate of comorbidity with other psychiatric disorders--the highest of all the anxiety disorders--have caused some to view it as an associated feature of a number of other disorders rather than as an independent disturbance” (Woodman 1). One of the first people to deal with anxiety in the medical community was Freud, who noticed that free-floating anxiety that occurred frequently in the general population (Woodman 1). Since then, generalized anxiety disorder was lumped in with other anxiety disorders such as panic disorder and social anxiety disorder. However, in 1980, the APA decided to separate “anxiety neurosis (DSM-II) into (1) panic disorder, characterized by spontaneous episodes of intense anxiety, and (2) GAD, a residual category for patients who have chronic, sustained anxiety without panic attacks (DSM-III)” (Woodman 2). This separation was made due to the different reactions patients had to imipramine and benzodiazepine for panic disorder and generalized anxiety disorder, respectively.

            The history of the medicalization of generalized anxiety disorder could also be understood as biomedicalization. Biomedicalization is similar to medicalization, but is further implicated by capitalism and the commodification of health (Clarke, Fishman, Fosket, Mamo, Shim R170). Biomedicalization can be understood as how “health itself and the proper management of chronic illnesses are becoming individual moral responsibilities to be fulfilled through improved access to knowledge, self-surveillance, prevention, risk assessment, the treatment of risk, and the consumption of appropriate self-help/biomedical goods and services (Clarke, Fishman, Fosket, Mamo, Shim R170).

            The biomedicalization of general anxiety disorder is found within the various medications marketed towards those with anxiety. In the mid-90s, many medications for depression flooded the market and demonstrated to pharmaceuticals that there was also the possibility of an “anxiety market” (Conrad, Leiter 163). They went to the FDA for approval for Paxil as a drug for panic disorder, obsessive compulsive disorder, as well as generalized anxiety disorder. Conrad and Leiter argue that the production of Paxil for these purposes “contributed to the medicalization of emotions, expanding medical jurisdiction over emotions such as worry and shyness” (Conrad, Leiter 163). Conrad and Leiter note how SAD and GAD were obscure disorders when they first became medicalized but gained traction as the wording for their criteria changed with the introduction of new prescriptions (Conrad, Leiter 163).

            The recent history of the medicalization of general anxiety disorder is highly implicated by capitalism and the market. Since the FDA approved the use of Paxil for SAD and GAD, “GlaxoSmithKline has spent millions of dollars to raise the public visibility of SAD and GAD, by sponsoring well-choreographed disease awareness campaigns” (Conrad, Leiter 164). Paradoxically, these campaigns defined these disorders as both common and abnormal. They were depicted as common in that the media campaigns demonstrated that many experienced these symptoms. However, they were still deemed abnormal as they were subject to medical intervention, in the form of Paxil (Conrad, Leiter 164). These marketing campaigns were very successful and made Paxil one of the top three most recognizable prescription medications in 2003 (Conrad, Leiter 164).

References

Adele E. Clarke, Janet K. Shim, Laura Mamo, Jennifer Rush Fosket, Jennifer R. Fishman. “Biomedicalization: Technoscientific Transformations of Health, Illness, and U.S. Biomedicine” (in reader).

Conrad, Peter, and Valerie Leiter. "Medicalization, Markets and Consumers." JSTOR. American Sociological Association, 2004. Web.

Woodman, Catherine. "The Natural History of Generalized Anxiety Disorder: A Review."MedScape Today. N.p., n.d. Web. 01 May 2013.

What is Generalized Anxiety Disorder?

            Within this section, I will provide an overview of Generalized Anxiety Disorder. I will discuss what constitutes a diagnosis for GAD and what its symptoms are. I will also provide statistics and demographic trends for the disorder. Finally, I will discuss prevention and treatment of the disorder.

            The Anxiety and Depression Association of America describes Generalized Anxiety Disorder as “characterized by persistent, excessive, and unrealistic worry about everyday things” (“Generalized Anxiety Disorder”). Those with GAD experience much greater worry and anxiety when going about their day-to-day lives which may be seen as irrational to those not knowledgeable about this condition. Generally, the threshold for diagnosis is six months of intense and excessive stress over day-to-day life (“Generalized Anxiety Disorder”). Physical symptoms often accompany anxiety as well including: fatigue, headaches, muscle tension, twitching, lightheadedness, and feeling out of breath (“Anxiety Disorders” 12). The prevalence and severity of these symptoms vary, with some people able to maintain their families and careers and some having trouble “carrying out the simplest daily activities” (“Anxiety Disorders” 13). Prevalence of symptoms is also correlated with periods of high stress. This stress also causes issues with the sleep cycle with many having issues falling and staying asleep (Rogge). These and many other factors cause those diagnosed with this disorder many issues in participating fully in everyday life. Next, I will discuss statistics and trends associated with this disorder.

Currently, it is estimated that 3.1% of the U.S. adult population has had prevalence of GAD within the last 12 months (“Generalized Anxiety Disorder Among Adults”). The average age of onset is 31 years with diagnosis typically occurring in someone’s late twenties and early thirties. Approximately 1% of the U.S. adult population has cases classified as severe (“Generalized Anxiety Disorder Among Adults”). The lifetime prevalence for ages 13-18 is 1% in the U.S. as well (“Generalized Anxiety Disorder Among Adults”).  Worldwide, countries in Europe and Australia have similar rates ranging from 2-3% for adults while Taiwan’s rate is .4% (Andrews). It is argued that rates vary from the westernized world due to the nature of diagnosis in other cultures. We can see these differences in Asian cultures since “anxiety may be expressed predominantly through somatic symptoms… while Westerners more frequently express anxiety through cognitive avenues” (“Understanding Generalized Anxiety Disorder”). The diagnosis of GAD is also far more predominant in women than men, with some estimates as high as double the rates of men (“Generalized Anxiety Disorder”). Typically, being female, middle-aged, widowed/separated/divorced, and low income increased one’s risk of diagnosis for GAD while being Asian, Hispanic, or black decreased risk (Grant). Next, I will discuss what are generally understood as the causes for GAD.
            The exact causes and mechanisms for GAD are still not well understood yet there are some factors that have been shown to increase risk. It has been found to be hereditary so some may have a genetic predisposition to the disorder. Traumatic and stressful events within life such as the loss of a friend or family member can also trigger the disorder (“Understanding Generalized Anxiety Disorder”). Those diagnosed also have a low tolerance for uncertainty psychologically. Next, I will discuss recommendations for prevention of GAD.
            Recommendations for prevention vary from organization to organization. Some recommend prevention on an individualized basis while some see the problem as a public health issue. Commonly used websites such as WebMD recommend a healthy diet, exercise, and reduction of substances such as alcohol and caffeine (“Understanding Generalized Anxiety Disorder – Prevention”). It is also recommended that individuals take time to relax every day and keep stressful activities to a minimum. While these prevention techniques are helpful, it is also important to remember what kinds of individuals are able to maintain a healthy diet as well as find time to relax during the day. It is also recommended to seek treatment early if you exhibit any signs. However, many people may be without health insurance or other means to seek a diagnosis in the first place. The disorder itself concerns issues that are generally considered to be manageable and within the realm of one’s control so seeking diagnosis would be rare for those unaware that this condition even exists. Organizations such as the World Health Organization see this as part of a greater public health problem. They recommend reducing the factors that cause stress in the first place such as economic insecurity and inadequate housing, food, and education (“Prevention of Mental Disorders”). By sustaining an environment that allows all individuals regardless of race, gender, or class to be able to live a healthy lifestyle and have time to relax, we can hopefully decrease the rates and severity of these disorders. Finally, I will discuss treatment methods and options for those diagnosed.
            There are many treatment options recommended for those diagnosed including therapy and medication. Those with mild anxiety often can be helped through talk therapy and Cognitive-Behavorial Therapy (“Understanding Generalized Anxiety Disorder”). The latter “helps patients develop healthier thought patterns” as well as ways to respond to anxiety-producing situations (“Understanding Generalized Anxiety Disorder”). When therapy alone is not sufficient to alleviate symptoms, medications such as benzodiazepines and anti-depressants are prescribed. While medication cannot cure the disorder, it is meant to help alleviate its symptoms. Support networks within family and friends are also considered crucial to one’s recovery (“Understanding Generalized Anxiety Disorder”). Combinations of these methods can help individuals cope with their anxiety and participate in society.
            From this overview, we can see how gender, race, class, and nation are implicated within this disorder’s diagnosis. The disorder is predominantly female as well as white. Those in lower socioeconomic backgrounds are more susceptible as well as less able to utilize treatment methods. Westernized nations see greater rates of diagnosis as well. These topics and more will be further discussed throughout this project.

References

Andrews, G. "Why Does the Burden of Disease Persist? Relating the Burden of Anxiety and Depression to Effectiveness of Treatment." World Health Organization, n.d. Web. 10 Mar. 2013.
"Anxiety Disorders." National Institute of Mental Health, n.d. Web. 10 Mar. 2013.
"Generalized Anxiety Disorder (GAD)." Anxiety and Depression Association of America, n.d. Web. 10 Mar. 2013.

"Generalized Anxiety Disorder Among Adults." NIMH. N.p., n.d. Web. 12 Mar. 2013.

Grant, Bridget. "Prevalence, Correlates, Co-morbidity, and Comparative Disability of DSM-IV Generalized Anxiety Disorder in the USA: Results from the National Epidemiologic Survey on Alcohol and Related Conditions." Psychological Medicine. Cambridge University Press, n.d. Web. 11 Mar. 2013.

"Prevention of Medical Disorders: Effective Interventions and Policy Options." World Health Organization, n.d. Web. 10 Mar. 2013.

"Understanding Generalized Anxiety Disorder." World Federation for Mental Health, n.d. Web. 10 Mar. 2013.

Introduction

Before proceeding with this project, I'd like to explain what brings me to this topic and what I hope to get out of this project in the end.

I intend upon researching General Anxiety Disorder due to my family's experiences with it. My mom has grappled with anxiety and panic attacks since I was born and it took me until high school to even realize that it was considered a disorder. I've slowly become more knowledgeable and understanding of these issues as my mom has applied for disability from the government. However, I'm still quite ignorant and know that there is so much more to learn from the biology of this disorder to how it has been treated by society.

I come to this project as a way to grapple with my own fears and anxieties that I could also be diagnosed one day. In high school, I thought that would mean my life was over and that all the work I've done for my education would be entirely for naught. I would live in fear of the world instead of getting to embrace it. Now I know these thoughts and assumptions were incredibly problematic and stem from society's views on disability. I hope to better understand where these thoughts originated from and learn to be more accommodating to individuals with this disorder.