A large percentage of folks are out of work with little hope of gaining employment. Many folks no longer care to read the news because of the overwhelming, angst-producing articles on crime, government corruption, reduction in pay coupled with an increase in the cost of goods, the impact of federalization and the uncertainty it brings to many, the breakdown of CNMI’s infrastructure, the drop in tourism and investments, and a host of other problems negatively impacting the community. For many, there seems to be no signs of improvement on the horizon.
There is a resulting feeling of hopelessness. Because of these and other factors, anxiety in the CNMI has reached epidemic proportions.
Some stress in a person’s life is productive and normal. Stress prompts us to accomplish our daily “duties”. It motivates us to go shopping when we need to buy food, pick up the kids from school, go to work, seek shelter when it rains, and a myriad of other daily activities. Yet, too much stress can “overload the circuits,” leading to anxiety, and even to depression.
It’s interesting to note how various cultures deal (or not deal) with stress. This is of particular importance in the CNMI. For example, Chamorros, Filipinos, and many of the Asian cultures, do not openly discuss their stressors or feelings of anxiety. It’s a subject often looked upon with “shame.” The consequences are twofold: 1) When families, friends, or co-workers do not openly discuss these issues, adults (and more so, the children) do not recognize the symptoms of anxiety. They may feel like something is definitely wrong but there is no point of reference for understanding those perplexing feelings, which is often the first step in appropriately dealing with the stressors. 2) Holding inside these feelings can often make the situation worse, like a volcano with the building of pressure and no place to vent. Alcoholism, spousal and child abuse, increased crime, drugs, etc., can be related to increased stressors within a community, such as is happening in the CNMI.
So, the questions become: How do I know if I’m “stressed out”? Are there any signs that tell me if my “stress load” is too high? Can these strange feelings I’m having be a sign of anxiety, or even depression? Are there any blood tests I should take? Should I be taking vitamins? The answers to these questions (which I hear nearly daily in clinical practice) really depend on the individual practitioner and his (or her) experience, intuition, ability to ask the right questions, and even the practitioner’s comfort level in dealing with anxiety and depression. As practitioners, we all have different approaches in dealing with stressors and anxiety among our patients. I tend to take a “head on” approach if I suspect a person’s symptoms are due to anxiety. I have a handout which I had first put together years ago and have subsequently revised to reflect social changes (the handout is a focused synopsis of this article you’re reading). If I suspect my patient is suffering from, say, anxiety or depression, (as opposed to diabetes, hyperthyroidism, or some other medical problem) then I’ll give the patient the handout and tell him (or her) to read only what’s printed in “The Box” section of the handout.
“ The Box” is a listing of The Frequent Signs and Symptoms of Anxiety. If I feel it’s better for the patient to digest this information in private, I may leave the office and give him some “space” to think about what he’s read.
But before I list the usual symptoms of anxiety, there is an interesting anecdotal story I’ve seen repeated in clinical practice over the years. Remember when I said that many cultures don’t openly discuss — and hence recognize — anxiety? If I ask someone whether or not they feel anxious, “stressed out,”, or depressed, and they answer something like: “No, I feel fine. I’m never “stressed out,” I think to myself that they may be in for a rude awakening. Even people with the best “coping mechanisms” to stressors have a relatively high stress load if they are living in the CNMI these days. On top of the usual stress people have in their daily lives (work, kids, family issues, no relaxing time or vacations, etc.), we are all overwhelmed with the major stressors currently existing in the CNMI (which I partially listed near the beginning of this article). It’s become a fact of life. And those very people who deny any stress are often the very ones who become most enlightened to the fact that they are very “stressed out” and exhibit many of the symptoms of anxiety.
Signs of anxiety
So…what are these signs and symptoms? Listed below is what I have printed in “The Box” of my handout. Go ahead and take the test: The Frequent Signs and Symptoms of Anxiety include:
1. Chest pain ( often poking or sharp), heart palpitations, rapid heart rate or “skipped beats, the feeling of unexplained tension or vague pressure in your chest.
2. Headaches, pain in the back of the neck and/or upper back.
3. Problems with sleeping or eating; changes in usual sleeping or bowel habits.
4. Feeling lonely, depressed, or lacking in self worth.
5. Tightness or “choking” in the throat or upper chest.
6. Difficulty concentrating.
7. Fatigue: feeling tired all of the time and — at times — not even wanting to get out of bed.
8. Not wanting to do the usual things one finds enjoyable (such as going to movies, spending time with your family and friends, or going out to eat). And, yes, even a decreased libido (or sexual drive) can be a sign of anxiety or depression.
9.Feeling “dizzy” or lightheaded.
10.Unexplained tingling or numbness in the hands and feet (unless, of course, you’re on winter vacation in Alaska)
11. The feeling of shortness of breath, hyperventilating, or unexplained inability to “catch your breath”.
12. Various stomach ailments, such as cramping, feeling “bloated,” intermittent diarrhea, intense gurgling in your intestines (in medical terms, this is called “borborygmi,” for those of you with a fondness for esoteric medical terminology), a change in eating habits from your normal pattern: eating a lot more than usual, or having little-to-no desire to eat.
13. Feeling “nervous, overly anxious, or having a vague sensation of not feeling right, or a general “discomfort.” The feeling of being different than others.
14. Easily angered. Over reacting to a given situation. Feeling “wound up.” Easily “annoyed” with your family members or co-workers.
15. Panic attacks may be associated with anxiety.
16. The feeling of “being different” than your friends, when you were growing up. Or the feeling of being “nervous” when you were younger. I see this occasionally among teens and it can be a predictor for future generalized anxiety. Adults who had these feelings when younger, are oftentimes good candidates for long term medication (we’ll discuss that in Part Two).
For those folks having anxiety, they may feel only some of the above symptoms. But those symptoms can become intense, over riding, and adversely affect their daily life. There are other less common symptoms not mentioned above, which I’ve heard described over the years. In general, if someone is experiencing one symptom of anxiety, it is likely that they will recognize other symptoms on the list.
It’s important to recognize that this is only a starting point. If you found that you are experiencing many of the symptoms listed, it is certainly likely that you are suffering from anxiety, depression, or some of both. Medical practitioners would be prudent in some situations to obtain lab tests to rule out such medical problems as thyroid dysfunction (too much or too little thyroid in your system), anemia, diabetes, and other lesser known disease entities which might mimic some of the symptoms of anxiety and depression.
It is relatively common for a patient who suffers from anxiety, to tell me that they have visited two or three other practitioners. The practitioners have ordered a battery of blood tests, X-rays, and EKG’s. When everything turns up normal, their practitioner shows the person that “there is nothing wrong with you. Everything is perfect.” I would disagree with that conclusion. At that point, I would surmise that the obvious diagnosis can ONLY be anxiety and/or depression. And these, like any other medical problem (whether it’s the flu, a broken arm, eczema, bronchitis, or a host of other disease states) must be treated appropriately and as a very real medical entity. And treatments are available.
So now the questions are: “What can I do about these weird symptoms now that my Doc has diagnosed me with anxiety”? And, ”Why do I suffer from anxiety and my Husband (or wife) does not, even though we have the same stressors?”
And that, ladies and gentleman, will be answered in Part Two of this series where we’ll review various treatments (both non-drug, as well as medication treatment modalities), discuss ways for improving coping mechanisms for the dealing of stress, and even see why some people suffer from anxiety, while others do not.
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