Editorial note: This is the second in a six-part series entitled "Pastoral Pressure Points" by Dr. Hart. The remaining four will appear in our May, July, September, and November issues.
At no time in history have so many lived so far from tranquility and so close to the precipice of anxiety. The events of past months, both the terrorist attacks in the U.S.A. and the anthrax scare, have moved the world further away from tranquility and peacefulness. The result is a rather dramatic increase in anxiety disorders, notably panic attacks. It is now the number one mental health problem for women in North America. In men it is second only to substance abuse. Needless to say, panic anxiety is also rampant among Christians.
Anxiety has always been with us. While the terrorist attacks will sooner or later abate, we will still be left with the major cause of panic anxiety, namely the pace of modern life. Mothers and fathers, children and grandchildren, and people from every strata of society are being pushed even further toward the edge of anxiety by the hectic demands of contemporary life.
Many experts are now saying that anxiety has become "epidemic." According to the National Institute of Mental Health (NIMH) more than 23 million Americans suffer from some form of anxiety disorder. The more serious of these include panic disorder, obsessive-compulsive disorder, and post-traumatic stress disorder.
No longer are we beset just by worry anxiety, which was the topic of my last article, but by more insidious and dam aging forms of anxiety. To quote the U.S. National Institute of Mental Health's Web site on this matter: 'They [anxiety victims] suffer from symptoms that are chronic, unremitting and usually grow progressively worse if left untreated. Tormented by panic attacks, irrational thoughts and fears, compulsive behaviors or rituals, flashbacks, nightmares, or countless frightening physical symptoms, people with anxiety disorders are heavy utilizers of emergency rooms and other medical services."
No pastor can function effectively in ministering to the needs of people today who is not aware of this dramatic increase in anxiety problems. Pastors need to understand and recognize the symptoms of anxiety disorders in them selves and in the people they serve.
Why the increase in panic anxiety?
Why has there been such a dramatic rise in anxiety, particularly panic attacks, in recent times? In simple terms it is because we are all overstressed and beset by the high expectations placed upon us. Combined with global threats and an unsettled world, we are being pushed to live at a pace beyond human limits.
The human frame finds the environment of uncertainty to be unsettling. We are all too hassled, too hurried, and too stretched for our own good. We were designed for camel travel not to be jetted about at supersonic speeds. This, combined with our failure to take time for rest and recovery produces the increased stress and anxiety and especially that which gives rise to panic attacks.
Unfortunately, panic anxiety has not bypassed our Christian subculture. In some respects it has impacted us more than anyone. Because we believe Cod is "in control" we expect to find ourselves relatively free of the anxiety all around us. The fact that we feel just as anxious and fearful only adds more cause for stress and anxiety. Needless to say, such beliefs are unwarranted. Because we are all part of a sinful and shaky world, we share in its uncertainties.
What can make a difference, however, is how we take and apply the resources of our faith to achieve a greater sense of tranquility.
What you should know about panic anxiety
Every human experiences anxiety. Some anxiety is necessary and normal. For instance, if you discover a lump in your breast you should begin to feel anxious. It serves as a wake-up call telling you to take action. It is an alarm of sorts. Such a symptom tells you to go to your doctor to have the lump checked. In this respect anxiety is necessary and helpful.
But there are, of course, other dimensions to stress. For example, pro longed stress has many deleterious effects, but none is more insidious than its depletion of the brain's "natural" tranquilizers. Stress hormones interfere with the balance of chemical messengers in the brain and ordinary anxiety becomes aggravated by a lack of the brain's natural tranquilizing agents.
This is the major cause of panic anxiety; a form of anxiety that has a sudden onset in which you are overcome by a feeling that something terrible is going to happen to you. It is often accompanied by chest pains and a hunger for air. These sensations may be strong enough to prompt the sufferer to seek emergency care because such symptoms may easily give a person the impression that they are having a heart attack.
Having a panic attack is a most frightening experience that only those who have experienced it can relate to. Fortunately, panic attacks won't kill you, although you certainly may feel your are going to die! Such attacks can be the most terrifying of all the anxiety disorders.
Because of the widespread misunderstanding and the stigma associated with anxiety, many people with severe anxiety problems do not receive proper treatment. They suffer unnecessarily, and their work, family, and social lives are disrupted.
Panic anxiety requires treatment
In my previous article I dealt very specifically with worry anxiety, a form of anxiety that is purely psychological in origin. Panic anxiety, however, is quite different in that it is biologically based and thus requires more than just a psychologically based treatment. If the problem is mainly the depletion of the brain's "natural" tranquilizers, this depletion must be treated.
Treatment may initially require the use of tranquilizers and /or antidepressants, which are provided to prevent further panic attacks while the sufferer makes the necessary lifestyle changes that will ensure long-term tranquility. The final "cure" is not accomplished until there has been a significant reduction in stress levels.
This means that effective treatment needs to include some good stress reduction counseling. While a few cases can be so serious as to warrant some years of medication, most should find a reduction in dependence on tranquilizers over a relatively short time.
Should Christians use tranquilizers?
Because treatment requires the use of a combination of tranquilizers and antidepressants, many Christians balk at getting any treatment for panic anxiety.
Herein lies the cause for a lot of unnecessary guilt, and pastors need to be understanding of themselves and others, and provide a supportive environment for such treatment. If this is not done intentionally, many will not seek treatment. Untreated panic anxiety can lead to permanent impairment in the more serious cases.
The question of the use of tranquilizers and other mental health drugs is one of the most vexing issues facing many Christians with anxiety problems. Pastors should be prepared to give an answer—and it should be an informed one.
The answer is: It depends on the type of anxiety. Worry anxiety needs spiritual and psychological help, but seldom a tranquilizer. Reason? There is nothing essentially wrong with the brain's natural tranquilizers. Brain chemistry is essentially normal. Worry anxiety is mainly learned, and it has to be unlearned. So if you or someone in your congregation worries excessively have him or her see a Christian counselor or a pastoral counselor for help.
If, on the other hand, someone suffers from panic attacks he or she will almost certainly need further treatment, and this will inevitably require a period when they need to be on medication of some sort.
A common misconception is that tranquilizers are the main medications used to treat all anxiety disorders. This has contributed to the belief among many Christians that tranquilizers "control" the mind and that they are addictive. For this reason many fail to seek the needed treatment. The fact is that not all anti-anxiety medications are tranquilizers, and the risk of addiction is high mainly when tranquilizers are misused. A competent doctor will not allow this to happen.
Although artificial tranquilizers are often necessary in anxiety treatment, they play a temporary and minor role overall. Other medications that are not addicting play a more important role in the long term. Furthermore, artificial tranquilizers work only because the brain has its own tranquilizers. So they are not foreign to the brain, which under normal circumstances, is constantly producing them.
Again, this is where stress plays its role. The brain's natural tranquilizers, or "happy hormones" as I call them, are robbed by stress. The greater the stress, the less of these hormones one has. It stands to reason, therefore, that until one can heed the warning call of anxiety and modify the lifestyle so as to reduce the stress levels, artificial tranquilizers may be necessary to achieve a tranquil life.
The consequences of not treating panic attacks
Every once in a while I encounter a person who has suffered from a bout of panic attack and reports that they have mastered the problem themselves with out any medication or other treatment. However, it invariably turns out that they did not have a very severe form of panic disorder or that they caught the problem in its very early stages. The fact is that the earlier the intervention, the better.
The truth is that for many, going it alone is not going to be ultimately helpful. For one thing, each successive panic attack only makes the problem worse. A "fear of fear" phenomenon develops in which the fear of further attacks feeds the underlying stress and almost guarantees that the problem will become more serious.
Aside from this, an effect called "kindling" can be set in motion. This refers to the fact that each panic attack makes it easier for the next to be "lit." Hence the fire analogy in the use of the word "kindling." The brain is primed to keep the panic attacks going on.
If treatment is being resisted
What are the consequences to which pastors can point if someone is resisting treatment?
The first is that if the current bout of panic attacks is not aborted as soon as possible the sufferer could easily become more disposed to repeated bouts of panic. It can become episodic. It takes less and less stress to instigate a bout of attacks.
The second is more serious. It can lead to the development of "agoraphobia," a condition where the sufferer is so afraid of having an attack in an unsafe place that he or she refuses to leave home. People suffering in this way become house-bound.
The term "agoraphobia" means "fear of the market place." Needless to say, this is a most detrimental outcome and it is more difficult to treat than the original panic attacks because it is more psychological in nature.
Specific words for Christians suffering anxiety
For pastors and the Christians they minister to, my message here is particularly important. We will be seeing more and more signs of anxiety panic disorder. Stress is not going away. The pace and demands of life are not slowing down or decreasing. We are not learning to rest more.
Along with this, many Christians have such a strong anti-medication mindset that they could be doing themselves serious harm by rejecting a short-term trial on an appropriate anti-anxiety medication, or by resisting some good Christian based therapy or counseling. Antidepressants are frequently the preferred medication and they are definitely not addicting!
Finally, as mentioned at the outset, many Christians are probably more prone to develop a high level of stress. We tend to be quite unaware of how pressures we feel trying to live "good" lives can cause anxiety problems. Being good by relying on our own resources is a lost cause. It is not what God wants from or for us. The harder we try in our own strength, the more our life becomes stress-bound. Our life in Christ should be a balanced life—with the natural tranquility God has provided built right into it.
There is no doubt in my mind that God intends us to live calm, serene, peaceful, composed, and good-natured lives—all qualities of tranquility. And this is precisely what Jesus promises us in John 16:33 when He says "These things I have spoken unto you, that in me ye might have peace." In these days of high stress and trauma we need to be more intentional than ever about seek ing this peace.