Anxiety Disorders among the Homeless and Others: No Laughing Matter
We can assist those who are suffering...
The Scream, by Edvard Munch.
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There are a wide variety of “disorders” plaguing the homeless—and people who are not homeless. The tradition in counseling those who are nervous or confused is to figure out the kinds of things bothering them, and then classify the nervous challenges into disorders. There is of course, even a manual to help professionals typify the obstacles and fears by using agreed-upon names for the illness face.
How do we know a homeless person is just not tired or apprehensive about some appointment or duty? How do we determine if somebody is reluctant to do something simply because they are uncomfortable in the situation? Most people have some activity they would rather avoid—perhaps going to the dentist or waiting for a long time in a line at the noisy an crowded grocery store.
What’s important to remember is that the anxiety that homeless or other person is feeling may be out of the ordinary. Not warranted, some would say. Strange or ridiculous some others might mention.
Your best friend says he’d rather kill himself than attend next week’s business meeting. Your spouse refuses to go to a party because there will be so many strangers attending. You overhear another friend saying she’s scared to death to give a speech at Monday’s board meeting. How serious are these people about their reluctance to be involved in these social situations?
We all know that being nervous about tests or speeches is a sign these events are important. We take them seriously because they have implications for our success. And they’re also a sign of whether we’re capable. If we’re victims of anxiety disorders, however, there is a great fear that rises in us. This fear makes us focus on all of the terrible results possible if we don’t perform well. As victims, we also focus on the fear itself.
If we’re anxious people, we get accustomed to our friends telling us our fears of crowds or of speeches or of public restrooms are unwarranted.
We often hear how childish we’re being or how irrationally we’re approaching one of these supposedly harmless events.
If we would “rather die than eat in a restaurant,” however, we probably have an anxiety disorder. If we truly mean we’d do just about anything to escape that dangerous, threatening, dreaded task, we need special help. The advice of our friends and loved ones is usually worthless in helping us understand and control the wild fears we have of certain events.
“In the case of an anxiety disorder, lay advice is generally bad advice,” said one expert I spoke to. She specializes in treatments for anxiety disorders, and she emphasized the following about advice on overcoming stage fright: “Pretending everyone in the audience has a monkey on their head is a strategy that will usually not work.” Only experts are equipped to deal with helping the patient understand the causes and cures of these disorders.
Understanding what anxiety disorders are and how they originate is very important. The causes can be a domineering parent or repeated abuse by a loved one or genetic factors—or a combination of these things. A patient has usually gotten the message he’s bad or incompetent or just plain hopeless. Salvaging the person begins with determining causes and getting the patient to accept the disorder as a challenge, as something which needs to be worked through.
It’s important to look first at what an anxiety disorder is not. These disorders are not something a patient has wished for or caused. They are the result of automatic responses. It is not the typical little bit of fear or apprehension everyone feels at the start of a test or speech. When the person who has to give a speech dreads it for weeks, then sweats, shakes, cries, runs from the building, and sometimes even collapses or becomes mute when the event starts, chances are it’s because of an anxiety disorder. These are responses which cannot be controlled on a conscious level.
One therapist I spoke to said, “People need to understand this sort of disorder is not chosen and is instead a set of complex somatic and other types of responses.” Try as one might to repress or ignore them, these responses can eventually break out. In so doing, they can prevent the patient from being able to perform his most important task at hand.
When a college professor has an anxiety disorder so extreme she can no longer get up in front of her class and teach, it’s obvious there’s something very wrong. Fear of failure, or an unresolved issue from her teenage years, or constant belittling by her husband or boss may be the reason she is finally overcome with anxiety. One person who suffers from anxiety issues said to me “Old problems can control us, exclude us from activities which are crucial to our careers and relationships.” That’s the nature of the best—it makes the patient’s biggest fears come true. “If you’re afraid you’ll mess up an important sales presentation, you can be guaranteed the anxiety disorder will make that happen, the person stressed further.
For people with such a disorder, though, it usually takes several bad occurrences to force them to speak up. Thinking it is their fault, perhaps, or that they are somehow choosing to do poorly, the anxious speaker or test-taker finds ways to cover up the problem.
When the problem gets too bad, professional help is needed.
One doctor I interviewed warned, “People often fear admitting they have a weakness or have something happening they themselves can’t solve.” Sometimes, the person is afraid of talking about personal or family problems because they consider these to be highly private matters. Helping these people to understand the counseling process is important at the same time they come to understand the anxiety disorder and the means for overcoming it.
The specialist went on to say, “Specialists start with the surface or most obvious problem—such as the anxiety attacks experienced during a speech—then explore causes and related problems.
Contributing factors such as substance abuse need to be dealt with also. Sometimes people with an anxiety disorder drink heavily to relax before or after a stressful event. “The use of alcohol or other depressants like barbiturates just exacerbates the problem, the specialist added. “These send very erratic messages to one’s nervous system—which is already receiving confusing messages from the anxiety.” On top of anxiety messages which are urging the person to scream or run out of the room, unclear thoughts brought on by too much drinking make the nervous system go haywire.
Once substance abuse or other contributing factors have been removed from the situation, and some possible causes of the anxiety have been determined, treatment can begin. Although there are several schools of thought regarding the treatment of the various anxiety disorders, all focus on getting the patient through the “fearful event” one way or another.
Some treatments get the patient to accept the anxiety as a welcome friend; others teach the patient to conquer past fears and replace them with positive thoughts and emotions for the future. Still others tell the patient to block the feelings of fear or to admit to the audience the tremendous anxiety being experienced during the delivery of a speech.
Homeless persons face extra anxiety, compounded by lack of sleep, lack of access to medications, and lack of knowledge about psychology. Helping inform them, and steer them in the right direction, has proven to be important on the street.
Professionals use a variety of pills and other treatments to help.
Various medications have also been used with some success. Xanax and Klonopin have been shown to be effective in anxiety disorder cases. They are very dangerous when used with alcohol or other sedatives, however. In general, medications such as these reduce some, but not always all, of the symptoms. Beta-blockers have also been used to stop some anxiety symptoms—such as the racing of the heart. However, if the person suffering from the anxiety has a tendency to dread events too far into the future, beta-blockers tend to be ineffective. Patients with this kind of “anticipatory anxiety” are perhaps much more afraid of the fear itself than of the event. Beta-blockers tend to work only during the actual event, and when it’s the event that’s the main source of the fear.
Whatever the treatment, the patient needs to understand the anxious feelings once controlled or solved might come back months or years later. These attacks have a way of resurfacing during stressful, highly-charged times.
As friends, managers, and colleagues, we can assist those who suffer from anxiety disorders by being both supportive and tolerant. We need to help anxious individuals rebuild their self-confidence at the same time we assure them they will overcome this problem.
Professionals who know a lot about the anxiety disorders, social phobia, and other such challenges should be called in to help the homeless and other persons deal with and manage their anxiety. As supportive listeners, we can do some things to help, but professionals are needed to do their part in the more advanced and technical plan to help the homeless or other person with their fears.
We can assist those who are suffering by locating therapists who specialize in anxiety disorders.
There is also a network of self-help groups connected to the Anxiety Disorders Association of America. For more information, please go to: www.adaa.org