Mental Illness on Martha’s Vineyard: My anxiety disorder

An Islander shares his struggle.

6
—Matthew C. Kramer

What word should I say? “Big” or “large”? Have I turned off the stove? Did I leave the door open? Is it locked at night? Am I wearing the “right” sweater? Did I drive down the “right” road or the “wrong” road?

When in the grip of anxiety, I have questioned my every single thought and action.

My anxiety is a feeling wrought with nervousness — constant and relentless doubt.

I worry I will do something “wrong.”

I know being reduced nearly to tears in the madness of trying to decide whether to turn left or right on a walk. The nervousness and doubt interfere with my ability to make a decision. I have walked back and forth for 10 minutes between the two options, with my hands holding my head — left? Right?

I fear the “wrong” choice. The wrong choice may lead to a bad or unwanted consequence. A left turn may be safety. A right turn may lead to total and utter devastation. This feeling of uncertainty is incredibly discomforting.

I used to cope with my anxiety by diverting attention — say a few words, crack a joke, looking to someone else. This strategy worked. But it also undermines one’s self.

It submitted me to my doubt.

Where it started

Looking back, I realize my anxiety began in high school.

I was shy and sensitive as a child, But I do not think I suffered from anxiety. I was one of the neighborhood gang of friends. I was popular in my school. I did well in my studies.

In eighth grade, I started to stutter. I could barely choke a sentence out reading aloud in class. I was humiliated and upset. I could barely look at my classmates.

I told my mother after school that day. She arranged for speech therapy, and after a few months I was able to speak and read aloud again.

My stutter would continue to dog me, though. My shyness became more of a nervousness in high school.

I was unsure of myself. Would I stutter, then would my voice and body quaver and shake when attention was on me? Would I fumble the shot in lacrosse? Would I hold my own in social situations with the opposite sex? The only place where I lacked all anxiety was on the cross-country course.

I had a lot of friends in high school. I was an athlete in two sports. We partied more than we should. We were just kids and did not know better. I went to the library and did my homework.

I did not speak much in class — especially French class.

In French class, we always had to read and speak aloud. I worried about stuttering. My junior year, I briefly ran for class president. My voice shook in my nomination appeal. I was embarrassed. My presidential bid ended.

I skipped our junior class party and hung out with some friends instead. We smoked pot. I reasoned at the time that I was too cool for the party. In truth, I now know, I was intimidated by the whole thing. I was afraid of the social expectations of the occasion — conversing and being confident and witty.

At the time, I did not know the cause of my doubt. I knew I was nervous in social situations. I knew I was self-conscious. I did not know I suffered from “anxiety.” I felt personally at fault. My lack of confidence was a weakness.

My anxiety really accelerated in college.

My doubt was no longer something that just surfaced now and then. It was full-throttle — a fully conscious and ever-present thought. I was amidst all of these young people growing into men and women. I felt like I was not one of them. I lacked confidence. I was a kid by comparison.

During my first semester, I was called on in geology class. All the students and the professor looked at me, waiting. I could barely handle it. My whole body shook. My voice shook. I was mortified. I knew what people were thinking: “The baby.”

I talked to my mother during my winter break that year, and she found a counselor for me. The counselor was a nice woman. We talked. But that was it. She gave me some meditation techniques and sent me on my way. I needed more.

One solution to my anxiety was to stick close to my buddies. I did not feel anxious in small groups of friends. Often, I had one really good friend and would let that person take the lead. I could forget my anxiety when I was with my pals.

We had fun in college. We had a good group of friends. We joined a fraternity. We went out to parties and hosted our own. Maybe not always the best use of our time. We relished our freedom.

I had a way of drinking too much on occasion. It went from fun to no longer fun. It was a way to keep up. Often I would become wretchedly sick.

College went along, and I managed. I kept up with my classes and coursework. I played some pool and a lot of foosball. I participated in the governance of the fraternity. I found a comfort zone. I had a girlfriend for a few years. She brought some joy into my life.

My stutter and fear of group settings were always at the back of my mind.

Without fully realizing, other than having talked to a counselor and my mother, I kept my anxiety buried. It surfaced in limited social situations and public speaking. I mostly could avoid these triggers.

My senior year, I stepped back from the partying and moved off-campus, renting a small house on the nearby lake with a few friends. I focused on my honors thesis in history, and had some success in my studies. I was manager for the crew team. How I wish I had run cross-country in college! I was a talented runner, and I think it would have given me some of the confidence I lacked.

 

After college

After college, I took on a variety of interests and endeavors. I worked on a presidential campaign. I sailed the ocean, working on tall ships and catamarans. I attended and did well in graduate school. I had a girlfriend and a few good friends. I later married and began a career.

I continued to experience doubt and nervousness.

I kept my anxiety at bay as best I could. I stayed under the radar, and avoided some social situations. It was easier that way. I did not have to feel or confront the uncomfortable and embarrassing nervousness. I did not fully realize what I was doing.

But it was impossible to keep the anxiety totally at bay. There were cocktail and dinner parties with folks I did not always know. I would be very nervous. I would feel a lack of confidence. I would envision myself stuttering, and a nervous tic in my lip twitching out of control. The other folks at the party would be humiliated for me.

Four years after grad school, I moved to the Vineyard with my wife and new daughter. I was excited to be in a new place with my family.

The move turned out to be difficult.

I had serious struggles with paranoia — unrealistic fears of a conspiracy to ruin me — that left me estranged from all of my family and friends. (My children were the only people in the entire world I did not include in the conspiracy.)

Ultimately, given my erratic behavior, my wife asked me to leave the house, and filed for a divorce. I moved in with my parents. I spent most of my time in my room writing a book. I had regular visitation with my children that I never missed.

I had left work and existed in this paranoid world for about five years.

Then I had my first intrusive thought. Intrusive thoughts are unwanted thoughts — symptoms of obsessive-compulsive disorder (OCD). They cover the most terrifying territory the mind can conjure. Whatever is the most disquieting thought in a given situation will be the thought a sufferer of this form of OCD will have.

Intrusive thoughts may be that you are going to harm yourself or someone else. They may appear as images in your mind of horrible things happening to yourself or the ones you love. Doomsday scenarios appear in your mind.

The scientific research — based on evidence-based studies — is clear: Intrusive thoughts do not increase one’s likelihood of acting on the thoughts. But that does not matter to the one suffering. The feelings are real, and they are terrifying.

For a while, I did pretty well, and my wife took me back. I managed OK for a while. But over the course of a year, the intrusive thoughts gradually took over.

In the depths of my illness, the grocery store and the Post Office were impossible. There were too many people in too small a space. I would be on the highest level of alert. I was afraid I might somehow hurt someone in passing.

 

Madness

I had one of my worst episodes walking around West Chop one day.

I thought I was going to throw myself in front of every passing car and truck. I felt in my mind jumping out into the road, the violent impact of the hood of the oncoming car crushing my body, and life leaving me. It took all the energy and control I could summon not to jump.

The effort left me exhausted. I descended into a state of madness. Whereas I had been hanging on — working on my book, doing chores and errands, having family suppers — I could now no longer cope at the most basic level. I was terrified by the intrusive thoughts and paranoia. I wanted nothing more than to not cause harm.

I isolated myself and ruminated over my fears.

I spent entire days in my bedroom. I skipped family suppers. I stayed away from the Post Office and grocery store. I withdrew emotionally. I lost my ability to have a conversation. I could not have a relationship — with my spouse, my kids, my siblings, my parents. I slowly and completely withdrew from the world.

My deterioration and my inability to function or participate in the household, and the roller-coaster experience of my illness, became too much for my wife. She asked me to leave the house, and renewed her request for a divorce.

Confronted with this loss, I finally agreed to try medication. For years, I had resisted medications, as I believed a goal of the “conspiracy” was to impair my abilities by putting me on potent medications that I did not need. But with the help of a counselor and the support of my parents, I was able to take the leap of faith necessary.

The medications helped. The impulsive feelings and the paranoid world I had created receded. After some time, I could converse again and interact with people. It was not easy. I spiraled into a major depression along the way. The depression was horrifying, and lasted about eight months. I did not want to live. But eventually the depression did lift, and I did have a return to some normalcy.

My recovery has been ongoing — with expected bumps — for about 10 years. I am no longer afraid of the Post Office or the grocery store. I can sit down to supper. I can have relationships again with my family and friends. (That has been my greatest reward for taking medications.) I can and do walk around West Chop. I have a job.

‘If you broke your leg, would you see a doctor or try to walk on your own?’

Anxiety remains. I experience severe doubt. I am afraid I will do something and lose my job and be ostracized. No one will be my friend. I realize intellectually these fears are unreasonable, but it still does not matter.

There is no medication that cures OCD. (My medication is more for paranoia.) I received a treatment called cognitive behavioral therapy (CBT).

CBT exposes one to their feared situations and teaches one to tolerate the anxiety. It is very effective. As you learn to tolerate the anxiety, the level of anxiety diminishes. (See the sidebar for information on getting help.)

Now I more often confront my anxiety, rather than trying to unload it elsewhere. I do not like how the anxiety feels. But it is my burden, and I know from experience that the anxiety will go away. I know tolerating the anxiety is the healthy choice.

I have a counselor. Counseling has enabled me to succeed again in a job in the community. A person with mental illness carries a burden that folks without mental illness do not. A counselor helps shoulder that burden. There is no shame in seeking help.

If you broke your leg, would you see a doctor or try to walk on your own?

Read another anxiety story, about a boy who couldn’t speak. 

What the professionals say

What the professionals say about anxiety disorder

Anxiety, according to the National Alliance for Mental Illness (NAMI), is a disorder that causes one to be overwhelmed with feelings of intense fear and worry in situations that are not threatening to people without anxiety. For many people, according to Dr. Charles Silberstein, head psychiatrist for Martha’s Vineyard Hospital, anxiety prevents their ability “to work, to play, to live, to have relationships.”

Anxiety disorders, according to NAMI, are the most common mental illness in the U.S., with an estimated 40 million adults, or 18 percent of the population. This would mean approximately 2,550 Islanders have a form of anxiety. Approximately 8 percent of children and teenagers experience anxiety. Most people develop symptoms of anxiety disorders before age 21, and women are 60 percent more likely to be diagnosed with an anxiety disorder than men.

Anxiety is no stranger to the Vineyard. More than 800 community members — parents, teachers, students — attended intensive workshops for parents on anxiety and children led by Lynn Lyons, a noted expert and author on anxiety, in December 2015. Ms. Lyons returned to the Island in December 2016 at the invitation of the Island Wide Youth Collaborative to lead three more workshops.

There are different types of anxiety. Generalized anxiety disorder, says Dr. Silberstein, is where worries become excessive. A trigger could be something as innocuous as a phone call not being returned.

“Oh my God, have I done something wrong?” may be the thought of a person with anxiety. Symptoms could be butterflies in the stomach, sweaty palms, and explosive diarrhea.

Panic disorder is another type of anxiety. Panic attacks, Dr. Silberstein explains, are discrete episodes that last from seconds up to two hours. The symptoms may be a racing heart, shortness of breath, a feeling of impending doom, and a need to escape but being unable to escape. “It’s intensely distressing, and often accompanied by a feeling they are going to die or have a stroke,” Dr. Silberstein says.

Some people have phobias. A phobia disorder is when certain things or situations cause severe discomfort or irrational fear. Phobias may be flying, public speaking, snakes, spiders, even gooey substances, according to Dr. Silberstein.

Social anxiety disorder involves intense fear of social situations and a worry of social humiliation. Folks with social anxiety might not speak in class and might isolate themselves, according to NAMI.

Obsessive-compulsive disorder (OCD) is another type of anxiety. Someone with OCD might check to see if the stove is turned off 10, 20, 30 times. Or, says Dr. Silberstein, “they might wash their hands until they’re raw and cracked because they feel they might be contaminated.”

Post-traumatic stress disorder (PTSD) is the “granddaddy of all anxiety disorders,” according to Dr. Silberstein, though it has less of a genetic component. It is characterized by reexperiencing trauma as much as 30 years later. For example, women who had been in concentration camps might wake up and smell the ovens. Other symptoms of PTSD can be hypervigilance, flying into a rage when someone triggers the memory of a trauma, or emotional numbing and shutting down.

All types of anxieties can interfere with a person’s ability to function day to day. “Each [anxiety] in their own way destroys life if it’s severe enough,” Dr. Silberstein says.

Scientists believe that factors such as genetics and one’s environment cause anxiety disorders. Anxiety can be treated with psychotherapies, medications, and stress and relaxation techniques such as mindfulness and meditation.

 

How to get help

For more information on cognitive behavioral therapy, OCD, and intrusive thoughts, one should talk to their doctor, or read one of the many books on the topics.

NAMI Massachusetts (namimass.org)

Martha’s Vineyard Community Services Island Counseling Center provides support for those struggling with mental illness, addiction, or crises.
mvcommunityservices.com/islandcounselingcenter
508-693-7900, ext. 290

Intake form: bit.ly/mvcsINTAKE

Island Wide Youth Collaborative provides support to families and children in crisis.
mvcommunityservices.com/iwyc
508-693-7900, ext. 400

M.V. Psychotherapy: Listing of psychotherapists on Martha’s Vineyard.
mvpsychotherapy.net

Lynn Lyons is an excellent resource (not Island-based, but lots of great info online): lynnlyonsnh.com

 

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6 COMMENTS

  1. According to mvpsychotherapy.com there is not a mental health person with an MD (who can prescribe medication) who takes ANY health insurance, including Dr. Silberstein. Can this possibly be true? The list does not tell you what degree the therapist holds, whether a social worker, psychologist, psychiatrist, etc.

    • That database may need to be updated – I think there are a few private practice psychiatrists on island who accept some insurance plans. The Counseling Center at MVCS has one child psychiatrist and two prescriber-trained nurse practitioners – all can prescribe medication. MVCS accepts all insurance and no one is turned away due to lack of funds.

      • I don’t believe there are any private practice psychiatrists on MV who take insurance. If I am wrong, please name them. People who pay their own health insurance should be able to see a doctor privately and be covered, but I do not believe that happens on MV– not a great place to have a mental illness, especially one that requires medication. I would not want a nurse– a person who has not gone to medical school and trained for years– to dispense heavy-duty drugs with side-effects to someone I love.

  2. I bet the next Eight years are going to really be tough for you, thank GOD you are not a veteran.. Good luck

    • The next 8 years are going to be tough on everyone not rich and white.And just so you know,I am a veteran,unlike the Cheeto in charge…

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