I taught mental health and addictions practitioners the dynamics of dual diagnosis back in the 90s. It was a challenging experience and a new way to see addiction as a mental illness and not a moral failing of weaker beings.

I talked about anxiety a lot and one of the things I said was that anxiety was the one mental illness that had immediate physical affects: sweaty palms, hyperventilation and other such symptoms. I was wrong, all of the mental illnesses and addictions have an immediate physical component. However, some of the physical symptoms are not as well known.

Anxiety does have a strong and immediate physical component, and this may be helping the confusion that exists today about anxiety. If you have ever had a panic attack, you know that heading to a doctor’s office feels right. It’s dramatic and of course, you feel ill.

Most people don’t know that mental illness is very well defined by the American Psychiatric Association. The Diagnostic Statistical Manual, aptly named the DSM, clearly identifies the symptoms associated with a diagnosis. It also defines the time parameters and number of symptoms required for the diagnosis. The DSM has been updated constantly and is now known as the DSM-5 TR (text revised).

Anxiety feels real serious, right away. And yet, anxiety is part of the everyday human experience. It tells you that something is important to you. The well-known “fight or flight response is part” anxiety.

Defining an Illness

Many young people who write to me question their own anxiety as if they already have a mental illness. What I am beginning to understand is that often, they do not have an illness. These young people are living with life and the current recovery from Covid. Because we experience anxiety does not mean that we are mentally ill, it essentially means that we are alive.

The Anxiety diagnosis is comprehensive and offers information about true mental illness. I find the crucial feature of the diagnosis is: “The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.” (DSM-5-TR).

Almost every day, I write about this component of mental illness. To be defined as an illness, you must have a loss in function in some other area of your life. That means you cannot: go to work, take care of your children, engage in meaningful relationships. Let me tell some stories about those who do not function because of anxiety.

A young mother who wakes up extra early in the morning before her shift, so that she can look at her sons safely tucked into their beds. She is able to go to work, but all weekend, she must stare (not watch) after her sons because if she does not, she is afraid that they will be hurt. During the weekend, she is unable to perform any function at all.

Another mother who cannot go out of her home without experiencing extreme panic once she is in another place. She can pull up to Walmart’s for groceries that are stowed in the trunk by a Walmart employee, but she cannot enter Publix, without completely losing her sense of safety.

A middle aged man who when going to work, tried to pull out of his driveway and always thought that someone was under his back tires. He would get out of his car, check his back tires and then get back into his car. He would then get out of his car and check his back tires again. He did this so many times that (if he could make it) he was always late for work.

Real Life Includes Anxiety

These are real people with anxiety disorders that can benefit from treatment.

If you are driving to a meeting with your supervisor and your palms get sweaty, that is usually NOT an anxiety disorder. That is living life.

When you see your child coming from school and something about the day makes your anxiety go away, that’s you, living life.

If your boyfriend hasn’t called or texted in a few days and it makes you pace all around the apartment, that’s you, living life.

You can’t get through life without fear, anxiety and pain. And when you do feel it, please know that, that’s you, living life.