The Mind, Explained (2019) s01e03 Episode Script

Anxiety

If I start taking very deep, quick breaths, you will experience what a panic attack is like.
And this is where I could actually do it, if you want me to.
- Yeah, let's do it.
- Yeah? I'm feeling cold.
My focus is narrowing.
Everything feels a little bit blurry.
I'm feeling tingling in my body.
Almost pins and needles.
Just warm all over.
Sweating like I was in the sauna.
It's feeling like it's harder to catch my breath.
Like there's nothing to breathe.
Mind was racing so fast.
I feel like I, um like I kinda want to get out of here.
And these sensations that I'm going through right now, this is what someone with a panic attack feels like.
Now imagine how scary it would be if all of these sensations came out of nowhere.
A panic attack is just one really intense, and by no means universal, form of anxiety.
Anxiety is the most common mental illness.
Thirty percent of humans or so are destined to be seriously impaired with anxiety.
There's a chance someone in the room where you're watching this right now has anxiety.
Why do so many of us feel this way? And what can we do about it? Here's what you need How to Relax.
You can start right now by thinking of some of the things that make you tense.
Once she's gotten these pills inside her, she knows that help is on the way.
Everybody is, uh, afraid of something or other.
This ailment is common to you, to you, and to you.
- Beginning to feel better? - Mm-hmm.
And this is only the beginning.
A warthog is not often sort of wallowing in the sort of anxiety that we think of in an everyday sense.
If you're a warthog, pretty much what anxiety is about is seeing a lion at the end of the field, so you better be vigilant.
The warthog's amygdala, the emotional center of the brain, identifies the lion as a threat, and that triggers the release of adrenaline throughout the body.
This is a brush fire of vigilance.
It prepares the body to face the threat and fight or to flee.
The warthog's heart is racing and breathing speeds up.
Lung passages expand and certain blood vessels dilate, all to make sure plenty of oxygen gets to the muscles needed to flee.
Those muscles tense, ready for action.
The warthog's pupils dilate so its eyes can take in more of the scene.
And then its peripheral vision shrinks to focus on the lion in front of it.
Other systems get shut down.
You got better things to do with your energy than digest breakfast or worry about reproduction or something like that.
The warthog stops salivating and digesting.
Blood flow is diverted away from the stomach, away from the skin, and nerves involved in arousal get turned off.
Everything that's going on in his body at the time is wonderfully adapted.
Anxiety evolved as a helpful emotion.
It has prepared the warthog to escape with its life this time.
If you're a warthog, there's a pretty good chance you'll eventually be killed by a lion.
But if you're a human, you're probably worried about other things.
We're smart enough to mobilize the exact same physiology as that warthog seeing the lion at the other end of the field, and we do it worrying about the 30-year mortgage we just signed on for.
"Oh, no.
Only three months until April 15th and paying taxes.
" Or "Oh, no.
How many more decades of this or that?" Or, "Oh, no.
This traffic jam is horrible.
" And the key thing in all those cases is we're filled with fear, we're filled with distress, we're filled with anxiety, and what your body is doing is every perfect adaptation to send energy to your thigh muscles to run for your life.
You can't fight or flee your taxes or traffic, but our body wants to respond just like a warthog when it sees a lion.
Think of the symptoms of stress.
Racing heart, tense muscles, stomach aches, a feeling of pins and needles, dry mouth, not wanting to or being able to have sex, all very familiar.
The amygdalas of humans with severe anxiety are overly sensitive.
They identify threats in everyday situations and set off this adrenaline chain reaction.
People with clinical anxiety see the world differently.
In one study, researchers showed people these faces.
Some were happy, some were angry, some were in between.
People with social anxiety disorder were more likely to say ambiguous faces were angry.
And people with clinical anxiety often can't reason their way out of the feeling, because the logical part of the brain is unable to rein in the amygdala.
And so sometimes anxiety can build and build into a full-blown crisis.
Had the experience a few times of having a panic attack at work while on stage.
My heart goes out to anybody who has to experience that on, you know, on a daily basis.
Maria Bamford has performed on many stages.
I had to take a break from work, uh, 'cause I went mental.
It happened before a show and I thought, "Oh, no.
" But I I couldn't I didn't want to stop doing stand-up.
When anxiety starts to get in the way of your life, that's when it becomes an anxiety disorder.
The different types of anxiety disorders can be grouped by the kinds of fears that are involved.
Catastrophic fears, these are beliefs that something really bad is going to happen.
This includes separation anxiety, excessive fear of being away from loved ones.
And then there are specific fears or phobias.
Arachnophobia, glossophobia, ophidiophobia.
Fear of evaluation.
That's the hallmark of social anxiety, the most common anxiety disorder, a persistent debilitating fear of being watched and judged.
And there's selective mutism, inability to speak in certain situations.
Fear of losing control.
It's a big part of panic disorder.
You fear the loss of control that comes with panic attacks.
Agoraphobia takes this to an extreme.
You avoid public places that might trigger an attack.
And a fear of uncertainty, of not knowing what's going to happen.
This area includes generalized anxiety disorder and obsessive compulsive disorder, or OCD, a fixation on impulses and thoughts.
We all have bizarre thoughts.
You think of, kinda like, "Oh, that dog is sexy.
" And then you go, "Oh, that's weird, eh?" And then you move on.
But somebody with an a tendency of O OCD goes, "Oh, it's weird that I just had that.
" That's when the loop begins, and then you start walking over to the other side of street when you see a Pomeranian.
So mine was I started to fear that I was going to physically harm my parents and my sister.
Um, that I would serial kill them, I guess.
I'd avoid knife drawers.
I don't want to make eye contact.
Oh, if I make eye contact, I gotta squinch my hands three times.
Just becomes this more elaborate ritual thing.
Then Then I finally, uh, Googled "creepy thoughts that are unwanted.
" And up came OCD.
Turns out it's a whole thing.
OCD is famous for its rituals: repeatedly counting objects, checking locks, or clenching your hands a specific number of times.
It's all driven by the fear that something bad will happen if you don't do the ritual right.
Where do all these anxiety disorders come from? Well, some of it is inherited.
If you have a parent with anxiety, you're more likely to be anxious yourself.
And women are up to two times more likely to have an anxiety disorder than men.
Anxiety also seems to have something to do with the balance of chemicals in your brain.
Probably the most famous one these days is serotonin.
There's a theory that people with anxiety have too little serotonin, the same imbalance that some claim is responsible for depression.
People with depression often do have anxiety, but the link isn't well understood.
And it turns out, no surprise, there's not just one neurotransmitter, brain messenger, that seems to be out of whack.
But that off-kilter chemical soup is just the start of the story.
The seeds of anxiety can also be planted by traumatic experiences.
Your brain is an association machine.
It connects things together.
That can be a very good thing.
If you get attacked by a lion that leapt out of a bush, well, now you're gonna associate that bush with fear, and so you you're gonna start avoiding those situations.
And that might keep you alive.
If you, as a human, are spending your early years seeing a loved one physically abused by somebody else, being tossed out on the street, being brought up as a refugee with shelling all around you, you're just another primate whose brain is being taught to have a lifetime of vigilance.
Take the classic, and pretty problematic, case of Little Albert.
In the Little Albert experiment, researchers took a small child and exposed that child to a white rat.
This soft, cute, cuddly rat.
The researchers would hit a steel bar with a hammer to make a loud, scary sound every time the rat came near.
So, in this experiment, the researchers were able to create a phobia, a fear of small white animals.
And Little Albert's fear grew from just a mouse to other objects as well.
A rabbit, a fur muff, even a Santa Claus mask.
Some people with anxiety do this too.
They over-generalize.
Harmless things take on irrational, scary associations.
When I was five years old, I watched Jaws for the first time.
I can still remember that that sound of Jaws, the In my mind, these things got paired up together.
So I avoided going in the water.
Never learned how to swim.
I would even, as a kid, stand up on the ledges of my bathtub because I was afraid a shark might come out of the drain.
It looks as if anxiety problems like this are becoming more common.
At least according to some measures.
In the past couple of years, anxiety products have become best-sellers.
The prescription of benzodiazepines, a kind of anti-anxiety medication, has been rising, and Google searches for anxiety are way up.
I think what's happening here is some of the stigma around anxiety is declining.
Most young Americans now see seeking mental health counseling as a sign of strength, unlike older generations.
It's definitely something that in media is being discussed a lot.
A lot has been written about the epidemic of anxiety.
And one particular culprit keeps coming up.
Social media may be causing more anxiety.
Social media is a fun distraction, but it can actually cause social anxiety.
- Social media - Social media Social media is causing the anxiety and depression increase You're scrolling through your Instagram feed and you see, um, everyone else's wonderful, amazing life.
If you're someone who's vulnerable to experiencing anxiety, you might experience it more in that situation.
And a lot of social media is designed to hold your attention, and anxiety is a powerful way to do that.
Teenagers who spend more hours looking at screens are more likely to have been diagnosed with anxiety.
And people who spend more time on social media feel more isolated, which can make the symptoms of anxiety worse.
But the takeaway is unclear.
Are anxious, lonely people just more drawn to screens? Or is social media really driving an increase in anxiety? I feel like we havecreated the automobile.
The automobile has gained complete penetration in society and everyone's driving around, and we haven't invented the safety belt yet.
But it's hard to tell if clinical anxiety is actually on the rise, because the way we define and study anxiety keeps changing.
If we look at research into how common anxiety disorders are, the rates haven't changed.
In 2015, researchers collected a few huge, rigorous surveys from the last few decades and they found no evidence that the prevalence rates of anxiety disorders have changed.
After all, this isn't the first time people have felt like they were living through an anxiety epidemic.
Back in Victorian England, people were very anxious about swelling cities, the gulf between rich and poor, and new technology.
This cartoon from a 1906 Punch magazine paints the wireless telegraph as a threat to natural human interactions.
Stressed out Victorians sometimes turned to laudanum, a mixture of alcohol and opium, to quiet their racing minds.
Across the Atlantic, Americans claimed their own special variety of anxiety.
Americanitis.
Women were often prescribed a rest-cure, sometimes confined to bed for eight weeks.
But some men, including future president Teddy Roosevelt, got the West cure.
They were sent to the western territories to live in cabins, ranch, and hunt in rugged outfits.
The period after World War II was another era of growth and change.
A refugee of that war, chemist Frank Berger, discovered a chemical that calmed down lab rats, but didn't knock them out.
By 1955, that tranquilizer was being sold as "Miltown," and quickly became the best-selling drug ever marketed in the United States.
It was such a sensation, one of America's biggest TV stars at the time, Milton Berle, even jokingly prescribed it on his talk show to Elvis Presley.
I'd rather have a quiet type of girl, someone more sedate, someone that'll that will calm me down and relax me, you know? You don't want a girl, you want a Miltown.
Big changes have always meant new triggers.
And that's something pretty unique to humans.
Unlike warthogs, we keep inventing new reasons to be anxious, reasons we can't fight or flee.
And every generation has struggled, with mixed success, to figure out what to do about it.
Worldwide, only about a tenth of people with diagnosable anxiety receive adequate treatment.
Most people who experience anxiety tend to try to just get through it themselves.
Some people drink to relax.
But alcohol can make anxiety worse in the short and long term.
Others turn to weed, and here, there's mixed results.
One compound in marijuana, THC, can increase your heart rate, so that may make some feel more anxious.
But there's early evidence that another compound, CBD, actually helps, at least in the short-term.
Then there's exercise.
If your body is keyed up for action with this misfiring fight-or-flight response, if it's looking for a way to close that loop Sometimes it could feel great to go work out, to get out some of that tension.
I exercise, I try to eat well.
I try to But no more than your average bear, and I don't think that is as helpful to me as meds.
There are lots of different types of anti-anxiety drugs.
There are benzodiazepines that make you more responsive to a sort of natural sedative found in your brain, and there are antidepressants that help you even out your serotonin levels.
They can do wonders to this sticky, obsessive ruminationabout sadness, and the same exact drugs working on the same neuro-chemical system can do wonders about that sticky, obsessive sense of fear and disquiet that anxiety is about.
And lots of other options.
Navigating them all and their side effects can be really hard.
My medication process took I mean, I would say about 15 years to find.
It's really, uh exhausting and and terrifying.
I'm in this business and proud of the progress we've made, but all things considered we are pitifully incapable of dealing with these disorders.
You didn't want to go on what I considered to be heavier, heavier drugs because I the side effects were a tremor and weight gain.
Ego, weight gain tremor, uh, also ego.
Uh, didn't want to tremor on stage.
Uh, but now, of course, weakness is the brand.
Uh, don't want to quash this cash cow.
And if someone were to say, "Well, that affects your comedy and you're not as funny," then I would say "Well, then, I would rather not be that funny.
" One 2015 review of 234 studies compared the effects of doing nothing, exercise, placebo pills, therapy, mindfulness meditation, and medication.
They found the most effective treatment was a combination of drugs and therapy.
One of the most popular types of therapy is cognitive behavioral therapy, or CBT, where you talk with a therapist to alter negative thought and behavior patterns.
For patients with anxiety, a specific CBT technique is often used called exposure therapy.
We create scenarios that activate these fears until you get to a point where you learn that you can actually manage these thoughts until those associations, they start to break down.
They had me, uh, record all my worst fears happening in real time in a script that I had written myself, and I had to listen to it over and over and over again.
You've made your parents into a Caesar salad and you've chopped them up into chunks and bits.
Just let your anxiety flood to the topmost moment and then find out that you don't die.
That you just you can't get any more anxious, and you're still fine.
And within, like, two weeks, something that had been a bane of my existence uh, at the age until 35, was gone.
I'm definitely I don't feel like, "Oh God, I'm better, stronger, faster.
" All I can do is, uh, just keep asking for help.
So I have a a text group of different female comedians who I can text if I, you know, have some concerns, saying "Oh, God, I feel so scared.
I'm so scared.
I don't think I can do it.
" And then they go, "Okay, well, that's okay if you can't do it.
" "Okay, well maybe I'll try.
" Thank you so much! Thank you, everybody! As a field, we used to think that we might be able to cure anxiety, and that, um, doesn't necessarily seem to be the case.
Treating anxiety is much more about learning how to experience anxiety.
We survive with the right amount of anxiety.
The plan is not to get rid of it.
The plan is to just have the biologically rational, real bases of it turning our systems on.
A few years ago, I was going to a psychology conference in Hawaii and my wife really wanted to go, uh, snorkeling and spend time in the ocean.
So I took swimming lessons.
I learned how to swim, I learned how to stay afloat.
And when he got to Hawaii, he headed out on a boat to go snorkeling.
I was so confident in that moment, because I had done all this exposure work on myself, and then our guide said, "Enjoy yourself, stay away from the giant sea turtles and don't mind the sand sharks.
" I had a 15-minute-long panic attack out there in the open ocean.
And what I learned from that experience is I could get through it and those sand sharks had absolutely no interest in me whatsoever.