The diagnosis of a disorder in relation to anxiety is always a question of fact and degree. It is perfectly natural for people to worry or feel anxious in different situations where a threat is present. Allowing for the sensitivity in the use of the words, our ability to foresee and predict has been essential to our evolution as a species. We survive because we see the risks in our environment and take precautions. Thus, drawing a positive line between “natural” anxiety and irrational levels of anxiety suggesting a disorder is always a matter of opinion – the victim of the uncontrolled anxiety sees the quality of life disappear, and objective observers see a need for intervention to protect the individual or others from the possibility of harm. This diagnosis can often be complicated by physical factors such as substance abuse. It may be necessary to treat the physical problems including, say, alcoholism, before or alongside the anxiety. Similarly, the presence of depression will require a different approach.
For the medical profession, the constant debate is how to strike a balance between the need to give effective treatment, and the healthcare model which, for the most part, is for-profit. Almost all the research during the last century proves the benefits of the various types of psychotherapy. Making the patient the focus of attention and relating to that patient as an individual with needs is, in itself, a major therapy. Allowing the patient the time to talk through problems and devise strategies for coping gives the individual ownership over the solutions – a necessary mental step in making the strategies effective. The moment you approach the patient as an inconvenience – reduce choice over treatment options in favor of medication – the majority either give up or grow defensive and resentful. Doctors have often responded by making treatment using medication compulsory. Listen to hospital administrators and they will tell you the cost of labor in providing psychotherapy to all patients is impossible to fund. Listen to the pharmaceutical industry and it will tell you there are effective drugs to cure all problems without the need for expensive therapy. In a capitalist model, medication therefore tends to win out over psychotherapy.
This is not to say that drugs like valium are not effective. In fact, the majority of people feel less anxious when they begin taking it. But drugs like valium do not “cure” the underlying problems. For that, you need physicians, psychiatrists, therapists, counselors and social workers to reach out to each person and offer support. With proper care, most people with anxiety disorders can live normal lives as self-confidence returns. This places valium in its most effective role – to provide a respite, a breathing space during which the psychotherapy can encourage the individual to start making the changes necessary for the anxiety to fade. For these purposes, the best type of psychotherapy is cognitive behavioral therapy where people are trained to rethink the way in which they respond to pressure. They are exposed to the feared social situations and grow less sensitive. They learn how to cope without worrying. It would be wonderful if you could patent this and put it in a bottle. The manufacturer would make a fortune and earn the profound gratitude of everyone who has ever had an anxiety or panic attack. Until then, we have to rely on talk as the best form of treatment.