Written by Lucy Nicholls
The stigma associated with anxiety disorders is still very much alive, writes Lucy Nichol.
Imagine sitting in a performance review at work and being told that you’re “neurotic”, “paranoid” or that your “personality is too up and down”. Unfortunately, I don’t need to imagine this scenario, because I remember it well. It has happened to me on more than one occasion throughout my working life.
Today, I am self-employed and mentally well – for the most part. Much of what I do – whether it’s writing a book, a magazine article or helping charities tell other people’s stories – is designed to tackle mental health stigma. So I know that the situations I have been in are far from unique.
It might be 2022, but mental health stigma is still all around us. Yes, language has evolved and awareness has increased – we have made great strides in those respects. But in practice, stigma is still causing harm. Whether that’s through a lack of services, workplace discrimination or shame and isolation, it’s hard to deny the significant role that stigma plays.
When it comes to anxiety, specifically, there’s also misunderstanding. Anxiety is, undoubtedly, part of everyday life. We can feel anxious about a job interview, moving house or going on a first date. And this anxiety might include physical symptoms such as a dry mouth, shakiness or shallow breathing. But this is often relative to life. Of course, some people might be more prone to such nervousness than others, but that doesn’t necessarily result in a diagnosis.
Something that might result in an anxiety disorder diagnosis, however, is having acute and regular panic attacks or becoming randomly convinced that the bus is going to topple over or that a small blemish on your arm is a deep vein thrombosis (I have experienced all of these). When these kinds of fears become overwhelming, and when they last for a good period of time (as they have for me in the past) then it’s worth speaking to your GP.
Anxiety disorders are not personality flaws
It’s important to note that an anxiety disorder is not a personality trait – and neuroticism is not a disorder (rather, it is considered one of the big five personality traits).
Yet all too often we hear people saying things like ‘she’s just neurotic’ or ‘she’s like the worried well’or ‘but she’s got nothing to be anxious about’. These kinds of comments, when used in relation to somebody living with an anxiety disorder, are incredibly harmful. And yes, it’s worth pointing out that the ‘she’ was used on purpose, because women are more likely to be labelled neurotic.
Writer and historian Catharine Arnold (who provided expert comment for my upcoming book about mental health stigma, Snowflake), said that medical use of the term ‘neurotic’ (which originates from a Greek word for ‘disease of the nerves’) dates back to 1769. Scottish doctor William Cullen coined the term to describe nervous disorders and symptoms that didn’t have a physical explanation. Arnold adds: “In the early 20th century, Sigmund Freud and Carl Jung redefined the term ‘neurotic’ in their psychoanalytic practice to mean external symptoms of an underlying emotional malaise and unresolved psychological problems.
“In 1980, the Diagnostic And Statistical Manual Of Mental Disorders (DSM) eliminated the neurosis category and the term is no longer used in psychiatric diagnosis. However, ‘neurotic’ remains in common currency as a pejorative word for people who struggle with life or are accused of overreacting to problems.”
Arnold explains that the reason women are more likely to be labelled neurotic in psychiatric terms relates to the number of women who typically present for psychiatric treatment. But this doesn’t necessarily mean that women were the only people needing such treatment – as men’s reluctance to come forward with mental health issues stems from a whole other layer of stigma.
Sadly, this idea that women are neurotic seems to have stuck. As Arnold says: “Today it’s often used as a put-down, a way of making women, in particular, feel inadequate. It has also previously been used as a put-down for people from religious and ethnic minorities. But rarely is it used to describe white men. Have you ever heard anyone accuse a male politician or celebrity of being ‘neurotic’?”
Of course, if we can’t find a rational explanation for our anxiety or panic attacks, and if we absorb the stigma that we are simply ‘overreacting’ to life and behaving like a ‘neurotic woman’ then we might start to believe that there is simply something wrong with our personality. But this couldn’t be further from the truth.
On those occasions where my personality was critiqued during a performance review, I was in fact experiencing acute anxiety – including the return of panic attacks. I was convinced that my throat was closing up, refused to eat certain foods and I kept looking in the mirror. I was convinced I had a serious physical illness and that the natural shape of my body or bone structure was actually a cancer. And I would get off the bus a couple of stops early because I thought it was going to topple over and kill me. And yes, I had informed my employers about my anxiety at the time.
But even though I have endured periods of acute anxiety, I am not ‘just a neurotic woman’. I take part in public speaking engagements, I have leapt out of a plane at 12,000 feet and I have called out bullying in the workplace (which is a notoriously difficult thing to do). So no, I’m not weak, and yes, I can handle life and I can take risks. But sometimes my anxiety disorder rears its ugly head and seemingly easy things – such as eating, drinking or getting the bus – become challenging.
But if you can’t voice these experiences or ask for help because you feel too ashamed or because you’ve been told you’re ‘just overthinking it’, the problems only get worse.
Stigma makes it harder for us to be kind to ourselves. It makes us angry and it stops us from seeking help because we feel we don’t deserve it. And that can be incredibly dangerous – an anxiety disorder can, in some cases, be life-threatening (I have heard of people living with an anxiety disorder who have died by suicide, which is an absolute tragedy).
If you’re tempted to call someone ‘just neurotic’ due to their anxiety, take a moment to pause and speak to them, and listen without judgment. Learning about what anxiety disorders really are by reading people’s real experiences (Mind is a great resource for this) is also helpful. Because while people with an anxiety disorder are often accused of ‘overthinking’ things – those using the put-downs are often not thinking enough.
Snowflake: Breaking Through Mental Health Stereotypes and Stigma by Lucy Nichol (Welbeck Publishing Group; £12.99) is out 5 January 2023.
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