Scylla and Charibdis appeared in the Odyssey of Homer as two sea monsters inhabiting opposite sides of a narrow strait, through which Odysseus was obliged to find passage. One, six headed Scylla, would leap from the sea and consume sailors as they passed. If a captain chose to avoid Scylla on his course, he inevitably then came too close to Charybdis. Charybdis lay beneath the surface and swallowed and disgorged huge amounts of sea water, creating gigantic whirlpools that sucked down passing ships.
It wouldn't take too much squinting to see Homer using the language of myth and poetry to describe the buffeting of the human psyche between anxiety, the many headed muncher of inner calm, and depression, always pulling us down into its whirling depths.
Having reflected some on depression in a previous post, here I am concerned with anxiety. I am prompted by an article I read in the most recent issue of Outside Magazine by Matt Samet--http://outside.away.com/outside/culture/201006/matt-samet-climber-addiction.html. Samet is a rock climber of considerable fame, and while now a freelance writer, was at one time the editor of Climbing magazine. In the Outside article, Samet writes about his struggle with anxiety, and the medications he was given for it.
Those meds were of a family known as benzodiazepines, which include Valium, Klonopin, Xanax, and others. He notes how quickly and desperately he became dependant on the meds, and how he never had trouble finding a physician who would prescribe them to him.
The medical thinking was that his panic disorder was evidence of a brain with chemicals unbalanced, requiring re-balancing with meds. Long story short, Samet experienced difficulties with his medications that far outstripped his original complaints regarding anxiety.
Anxiety can be said to be the powerful sense that something catastrophically dangerous is about to happen. For example, a saber tooth tiger is outside the cave. But for us in the 21rst century, our saber tooths are often abstractions. Our sophisticated brains can see a saber tooth in a column of numbers, the morning light, or even a brief contemplation of the unknown future.
Samet's article describes how he eventually came to understand that his real problem lay in the use of the anxiolytic meds he was taking, and that his 'underlying panic disorder' was nothing more than his dependancy on them.
In my own practice, I am well acquainted with patients taking various medications for depression and anxiety. My observations of patients taking SSRI's since their introduction in the late 90s lead me to conclude they do little if anything therapeutic for patients experiencing the mild to moderate depression of everyday life. However, they almost always cause side-effects, and these cause patients, in their naive, often desperate way, to think the meds 'must be working'. Please note, I am NOT talking about major depression- in this case, I have seen therapeutic results of SSRI treatment.
And to this I would add that I've never seen anything therapeutic come out of patients' use of benzodiazepines, which in my experience would primarily be Ativan and Klonopin, two of the most commonly prescribed anxiolytics. Yes, the meds are fantastically effective at ameliorating or even eliminating the feelings of anxiety or panic. Xanax yields a beatific calm that becomes almost impossible to resist.
But, people do not learn to deal with their anxiety when they are in the medicated calm of a drug.
Millenia ago, Homer was indicating that anxiety (Scylla) was a part of Odysseus' journey home. From this we can conclude that to be human is to be anxious, and that to find an effective route past it is part of the trip. We cannot usefully medicate human nature. It is possible to learn that anxiety will not kill you, that in fact there is nothing really wrong with anxiety. It is unpleasant, yes. A panic attack can scare the living crap out of you. But the medicated solutions are even worse.
The search for a drug solution to anxiety can lead a person into a dependancy on meds that takes root before he or she is even aware it has happened. Tolerance develops quickly and leads to more drug seeking, higher dosages, variations of drug combination. Fear of dependancy sets in, and the person attempts withdrawal. This then unchains all the chemical demons lying in wait for the unwitting. The suffering from benzo withdrawal is so intense that it leads almost inevitably back to more drug use and ever higher levels of dependancy.
The person is no longer dealing with the relatively manageable issue of anxiety, but is rather dealing with the monstrously unwieldy business of drug addiction. And that is the problem with the anti-anxiety meds. It is their very effectiveness and the brain's rapid adaptation to them that make them dangerous.
Anxiety won't kill you, but drug addiction will.
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