Anxiety, children, young people and their families.
When I first tried to play the guitar and sing in public, it did not go very well! I had practised my songs at home for hours and knew I could play them proficiently, but when I stood up in front of that crowd in the new place, I froze. My fingers would not move properly, I felt sick, I could not remember the words, my airways clammed up, I struggled to breathe, and I even struggled to stand! My legs were shaking. I could not play or sing at a basic level, and the more I thought about what I was doing and tried to focus and resolve things, the harder it got. I persisted and stumbled through, but if it was a memorable performance, it was for all the wrong reasons!
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It would have been easy to quit trying to perform music in front of people following that experience.
In time, however, through facing the challenge, exposing myself to the fear, learning to control my body and mind, getting advice from others who had done it, and with lots of practice, I became much better at it and overcame the anxiety. I even came to re-appraise feelings of anxiety as excitement, which gave me more energy when performing. I may not be Freddie Mercury, Jimi Hendrix, Paul McCartney, or Pavarotti, and I still have setbacks from time to time, but I enjoy performing, and hopefully the audience enjoys it too. It is an area of my life that brings me joy and helps me cope with other problems. I am grateful for it, and I am so pleased I did not give up!
Our minds have evolved for survival from our pre-human ancestors and then over thousands of generations and for a hugely different environment to that in which we currently live.
In primaeval times, to survive, we had to be hypervigilant to threats in the world around us and sensitive to monitoring and maintaining our status in the social group on which we relied.
Everyone is affected by anxiety at times in certain circumstances. Stress, anxiety, and associated adrenaline, at the right level, can help us achieve things and motivate us. For some, though, particularly among young people, it can become persistent and overwhelming, and, at a certain threshold of severity, persistence, or duration, it may be diagnosed as a "disorder." If not tackled early, it can also lead on to other mental health difficulties such as obsessive-compulsive disorder, eating issues, depression, and personality problems.
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Younger generations have perhaps been brought up with a degree of overprotection with respect to some threats without the freedom to explore and make mistakes, but this is combined with free access to a "wild west" of unregulated exposure to social media, graphic imagery, real-time, 24-hour news reporting of global threats, echo chambers of unbalanced information from "deviant’ subcultures, relentless bullying, potential exposure to online "predators," personalised marketing, monitoring and influence, and continuous stimulation.
There is an evidence base for psychological, lifestyle, and pharmacological interventions that can help with anxiety and related disorders, but if we can intervene at an early stage, with the right support, mentoring, learning, and advice from someone the person can relate to and trust who has tackled similar challenges themselves, more serious problems can be prevented.
We can achieve more mastery over our own body and mind, even if we can’t control the world around us.
If this is combined with family support so that those closest to us can constructively join us on our journey too, the chances of success are much higher.
If we can feel happy and like we are contributing, we can achieve so much more than if we are pressured and anxious. External experiences and circumstances play a more limited part in contributing to our happiness than we might appreciate. Shifting a mindset to embrace gratitude, recognising and noticing positive experiences, exercising, meditating, and engaging in acts of kindness, can all help us lead more contented lives and tackle inevitable challenges and obstacles in a way that helps us grow and develop. But we are social beings, and it is often through relationships that a positive shift is experienced.
As a psychiatrist, I am often frustrated that we have not made more progress in the years of my practise in achieving breakthroughs to improve people’s mental health. Medication can certainly be helpful in tackling anxiety, depression, psychotic episodes, and ADHD, but the balance of benefits and risks with respect to antidepressants for children and young people, for example, is less clear cut than for adults. We have learned more over the years about how psychological, behavioural, and social interventions may make a difference, but if a young person cannot relate to and does not engage with a therapist, it is impossible to implement an intervention, even with the strongest evidence base.
I am also the father of a son who experienced major problems with anxiety that developed, despite some intervention, into more severe mental health problems.
The repercussions of mentally traumatic experiences during key stages of childhood can be very difficult to address for any family, certainly without outside support and perspective. We all need some help sometimes, and that’s okay. But we need timely help. The experience for families so often is that they are put on a long waiting list or effectively asked to go away and come back when the problem is worse. It is not helpful to blame anyone for this state of affairs. It is just that the resources available, how society values them, and the way they are deployed do not currently meet the needs of so many families within the population – and this is an international problem.
Working closely, through a structured approach, with schools, with parents and families and engaging with children and young people through those they can relate to are part of the solution to addressing these challenges, alongside traditional specialist mental health services. While offering this, we need to continuously monitor and measure the impact that our interventions are having on people’s lives. So that we can keep learning what works best in general and apply it to each individual in a way that works for them.
