“Chaos is the law of Nature, Order is the dream of Man”

— Henry Adams, American historian

A few months ago, I was asked to see a young man who left a well-paying job in the UAE and came back to Pakistan because he was convinced he had developed a deadly illness. The ‘symptom’ developed while he was driving his car at night and had an accident. No one was injured. But following that incident, he developed a fear of being alone and had difficulty sleeping. Later, that evolved into some minor difficulty in swallowing after which he became convinced that he had throat cancer. He also developed muscular twitches and jerks (a common symptom of anxiety), which led him to believe that he had some kind of deadly neurological illness. He went on the internet and convinced himself that he had a debilitating neurological illness that was progressing and will result in paralysis and death.

What is anxiety?

Like many emotional disturbances, anxiety is an exaggerated version of the same emotion that all of us have experienced many times. If you have ever been disciplined by a parent or an irate boss, taken an exam, gotten married, faced a court case or been in an accident, you know what anxiety feels like: the same symptoms outlined above which generally resolve promptly after the stress dissipates.

What would it be like if the symptoms persisted hour after hour, day after day, week after week, and month after month?

The moment you wake up you feel the panic; your heart races; your stomach grumbles; your mouth is constantly dry; you feel as if you are about to choke or die. This is the daily experience of those who suffer from anxiety disorders where a normal human emotion magnifies and grows until it dominates every waking moment.

Here is a scene played out several times a day in my clinic. A person walks in (of either gender, although women outnumber men). They can be any age, from teenagers to people in their 80s or older. They all complain of the same thing: feeling restless, anxious and unable to relax. There is an impending feeling of doom, as if something bad is going to happen. They have a variety of ‘physical symptoms’: dry mouth, sweating, palpitations, stomach problems (‘gas’, bloating, diarrhea or constipation etc) and many others. They have seen numerous doctors, undergone medical tests and yet, nothing has been found. All their doctors have told them there is nothing wrong with them.

Anxiety and social circumstances

When I see a person with symptoms of anxiety, my first task is to explain the ‘mind-body’ link i.e., the idea that their ostensibly ‘physical’ symptoms are, in fact, being caused by that nebulous, mysterious phenomenon called ‘stress’ or ‘tension’, and that they need to stop going to different doctors and spending thousands on unnecessary tests, CT scans, X-rays etc. Once we get past that conversation and start discussing solutions, we come up against a thornier problem: can you help a person with anxiety get better when the world around you is falling apart (or appears to)? Inflation, unemployment, IMF, terrorism, Covid, dengue, more inflation, monkeypox… the list goes on. As a breathless TV anchor recently asked me on camera: “Doctor sahib, are we being punished for our sins?”

We can feel better despite everything happening in our society (and globally). And while it goes without saying that offering reassurance and platitudes to a person struggling to feed his family is meaningless (and duplicitous), there are many ways to feel better if you are struggling with anxiety.

Self-help for anxiety

Some steps that everyone can take to improve symptoms of anxiety (and enhance their quality of life even if they do not have anxiety) include:

Getting at least 7-8 hours of uninterrupted sleep a night. Sleep is such an essential component of both mental as well as physical health that it deserves a separate column. Suffice it to say that if there is one thing most of us can do to help improve our lives on a day-to-day basis, it is to get good quality sleep.

Eating a healthy diet. This too is a very general piece of advice that can not only improve most mental health conditions but also improve physical health and generally increase energy levels and productivity. More fresh fruits and vegetables, salads, lots of water, lean protein and healthy fats (such as those found in nuts) and as little processed food, salt and sugar as possible will help.

Regular physical exercise; at least 30-45 minutes at a time, at least 4-5 times a week. The type of exercise matters little. Walking, cycling, gym, swimming, even vigorous housework counts. The important thing is to move and to do it regularly. Exercise has huge benefits for both your mental and physical health.

Avoidance of excessive use of alcohol, drugs and other mind-altering substances. On the same note, limiting our use and consumption of media, including all forms of social media can help focus, concentrate and reduce anxiety.

Other things include making time for leisure activities such as spending time with family and friends; improving the quality of your relationships (which a professional can also help with); learning how to deal with deadlines and projects in a healthy way; and learning and practising specific activities that reduce anxiety such as meditation, yoga, breathing exercise etc. Nowadays, there is an app for pretty much everything and one can learn basic principles for all of these things and more if one invests time and energy.

If you are doing all of this and still find it hard to manage anxiety symptoms, it may be time to consult a professional. A psychiatrist may prescribe a short course of medicines to help, and a qualified psychologist can provide psychotherapy (“talk therapy”) sessions, which can be tremendously helpful. It is important to find the right person, someone who is both appropriately qualified and also a good fit for you.

Even if it seems like the world is falling apart, a change of perspective can make a world of difference.

The writer is a psychiatrist and faculty member at King Edward Medical University. He is the author of Faiz Ahmed Faiz: A Biography, Sang-e Meel Publications, 2022. He tweets @Ali_Madeeh