‘How are you?’ she asked.

I was at the dentist for the first time in years.

‘I’m really, really anxious’.

‘That’s normal’.

She was right, of course. Most people without clinical anxiety get nervous about going to the dentist. But most people, if they’ve never had more than one painless filling in their whole life, don’t generally tend to work themselves up for years about the dentist, freak themselves out to the point that it disrupts their life and sleep, and become so anxious that the stress creates physical pain in their gums and teeth for weeks on end which just exercebates the whole situation.

The mental stress created physical pain for no reason, by the way (isn’t the human body insane?). I worried and obsessed for three years about my teeth falling out and having horrible diseases and being told off for not getting my filling replaced and failing to book 12 appointments and what it meant that I wasn’t taking proper care of myself…and there was absolutely nothing wrong with my teeth.

A rational person would have just bitten the bullet, said, ‘Well, I may as well go and get it over with,’ long before it got to that stage, and saved themselves years of stress. A person with heightened anxiety can’t even deal with thinking about the idea for a few seconds, let alone actually end up sitting in that dentist’s chair.

There’s been a big push towards mental health recently. Mostly it’s been people telling each other that it’s a really important topic that doesn’t get talked about enough. It is really important. It doesn’t get talked about enough.

But most people only talk about the fact that it should be talked about. People who aren’t affected themselves usually want to help in a theoretical way, in a nice way that consists of sharing links to meditation tips and suggesting mood apps and buying workbooks for writing thoughts in, because it makes them feel better (when the shit actually hits the fan, these are the people who tend to get mad or disappear or fail to understand what it’s actually like). Of the people who’ve been/go there themselves, not many are willing to share their actual stories.

And I think that’s okay, for many reasons. It’s not necessarily helpful to revisit bad places. People are entitled to hide what they want to hide and share what they want to share. Sometimes they want to protect other people. But if you want to share, then you should, and other people should respect that. I’ve had people say things to me like, ‘I can’t believe you shared that on Facebook!’ And it’s not a picture of me drunk or half-naked or doing something illegal or attention-seeking, but a status update that’s a friends-only genuine cry for help saying that I’m having a bad time.

You can never win on social media.

‘Serious’ or not?

One difficult thing about anxiety, depression, and most similar words is that they get tossed around a lot by people who feel those emotions but not in the medical sense. My dentist example above is fairly mild, but the reason for that is to put clinical anxiety into a context so that those who don’t suffer from it can understand a bit more. I’m trying to avoid phrases like ‘true anxiety’ or ‘real anxiety’, because all anxiety is legitimate. (I’m trying, even if I don’t quite make it in places). It’s a vague term. One variant isn’t more ‘real’ than another, but the end effect is like the difference between feeling slightly uncomfortable because you’ve eaten too much versus full-on vomiting from food posioning.

So how do you tell the difference between the ‘normal’ anxiety before a dentist appointment, test, interview, big event etc., and an extreme reaction? (This is purely my opinion, by the way, based on my own experiences, and those of people close to me who are fellow sufferers). Some anxiety has physical effects, like panic attacks, sweating, shaking, and so on. Those aren’t things I’ve really had too much experience with, luckily. Physical symptoms are generally attributed to something else or aren’t believed or are thought to be exaggerated by people who don’t get them or who don’t understand anxiety. For most people with anxiety, a feeling of panic is a common manifestation. If you’ve ever thought you’ve forgotten something important – your keys, or a ticket, or money – and rummaged through your bag/pockets worriedly and hastily, it’s kind of like that. If you’re anxious you’ll have many thoughts like that, a lot of the time about things that aren’t important, and then repeatedly check or think, re-think, and over-think.

I’m an anxious traveller. Despite the hundreds of train journeys, flights, boats and trips I’ve taken, where things have gone wrong only a couple of times and been easily rectified, I still worry. Even if I’m only going to a nearby city for a day trip, I act like I’m going away to the desert for months. I need to tidy the house before I go. I need to get my tickets beforehand and check them a thousand times and calculate and re-calculate the time I need to leave and consider all the potential possibilities of everything that could make me late…and then I get anxious about what to take, whether the house is secure, if the cats will be okay, etc. etc. Anxiety is like anything else. If you repeat it, it becomes a habit. This is why every time I go to the cinema, I have completely irrational anxiety about my house being burgled. Is everything locked up securely? Of course it is. Do I worry about being burgled when I go out for dinner or to work or in a million other contexts when I’m out of the house? Nope, just the cinema. Have I ever been burgled while at the cinema? No (touch wood). Serious anxiety is illogical, and that’s one of the key differences.

In many cases, people’s anxiety manifests itself in their thoughts and thoughts about their relationships with other people, and that makes things even harder and more complicated. It can ruin your life if you have anxiety about a person but you need to work with them, or see them a lot, or they have specific triggers for you about something you’re sensitive about (life achievements, weight, salary, etc.). Sometimes it’s enough to bring these thoughts into consciousness or to take a step back and consider them in a different way. One good tip when anxiety hits is to think, ‘Nothing at all has changed now compared to five minutes ago, and I was feeling fine five minutes ago so I have absolutely nothing to worry about now’. Sometimes anxiety isn’t that easy to pinpoint, and even if it is that doesn’t mean it can be easily fixed. It’s a question of managing it where possible and trying to activate a logical voice or distracting yourself with something else.

Another test of anxiety is everyday tasks. I went through a phase a couple of years ago where I had to talk myself into leaving my house and walking to walk every morning. Walking to work is a totally standard, very easy thing that I’d been doing for years. Absolutely nothing had changed about the journey or my routine, yet suddenly, for some reason, it was nearly impossible to get myself out of the door. I spent a lot of time being frustrated with myself – it was such an easy thing to do, that millions of people do every day without thinking twice – hell, that I’d done every day without thinking twice, and suddenly it became a huge obstacle. People have their quirks, but if you start finding simple every day tasks a challenge for no reason, especially if they’re things you’ve done fine before, then it could be a sign of anxiety.

What’s the difference between anxiety and depression?

Suffering from both for a long period of time, it all tended to blur into one for me. This caused me problems with friends who had one or the other and apparently got really offended when I couldn’t always distinguish between the two. (I’m making my friends sound awful in this post…honestly, they’re generally great about this stuff!).

The simplest way I distinguish between them now is thinking of them like a sprint vs. a marathon. Anxiety is like a sprint: you’re pumped up ready to go (fight or flight), you’re on edge, your heart is pounding, and you know it’s intense but will be over fairly quickly. Depression is like a marathon: you start slow, it feels like it goes on forever, and it’s still incredibly demanding on your body but in a less immediately intensive way (see The Third F). With depression, I find I feel lethargic and generally rubbish about life. I don’t want to do things I normally enjoy. I get tired very easily. With anxiety, I like to avoid people. I might go out, but I’ll walk rather than get public transport. I might go out for a meal, but I’ll ask Joe to sort out the paying or pick something for me to eat.

How does having anxiety change your life?

how it changes your whole life – gearing up to things. explaining yourself. being taken by surprise and having a total meltdown. people who understand. people who don’t understand.

How is anxiety treated?

I was diagnosed pretty late, at around 26, and even then it was half-hearted. Because I didn’t fit into an easily definable box, like ‘anorexic’ or ‘obsessive complusive’, the diagnosis was pretty vague. Generalised anxiety disorder was hinted at, but the focus was almost always more on depression. When you’re that kind of ill you’re asked endless questions and fill out endless questionnaires, which is fairly useless for someone like me who can totally change from hour to hour or day to day. For that reason, I was sometimes diagnosed as more anxious than depressed (looking back, that was always when I answered questions after having an unrealised anxious episode), so I was treated for both, but since depression has a longer-term impact, that was usually the focus.

Treatment for anxiety really comes down to what your doctor prefers, at least in the UK. This is pretty dangerous in my opinion, because there isn’t enough focus on cause-led treatment. Genetics and life experiences aren’t separated out enough, and I hope there’s more work and research done around this in the future. Some people react better to medication, some therapy, and often they recommend a mix of both. To be honest, I didn’t have a massive amount of success with either. Therapy, like cognitive behavioural therapy, and related elements like mindfulness and meditation, are really useful if your thinking has become skewed for whatever reason. Medication is useful for physically calming you down or to resolve physical chemical imbalances.

If you don’t resolve any/all issues at the source, anything else you do is going to be of limited help in the long term. Again, my opinion. This applies more to depression than anxiety; anxiety can be crippling but a lot of the time it has a clear trigger. Sometimes the trigger is totally unavoidable, for example if you have anxiety about food (you have to eat, after all). Avoidance vs. facing issues head on is a whole other blog post in its own right. Like any other mental illness, you have to work really hard. You give up a million times and, somehow, come back fighting.

You can beat it, even if it doesn’t feel like you can.