Challenging the medical model: Anxiety

Anxiety is a biological mechanism specifically engineered to keep us safe from threat. If we think about anxiety as being like a fire alarm system, anxiety activates a warning system in the brain, in response to a potential threat and prepares the body to act in accordance with this threat.

When the brain perceives a threat, it produces stress hormones that send signals that the body to react. These hormones force the body into choosing a stress response; fight, flight, freeze.

It’s important to understand that this is an innate reaction and whichever response seems the most logical in terms of our survival, will be activated.

Anxiety presents in a number of ways some of which include:

• intense feelings of panic and/or dread
• churning in the stomach
• feeling light-headed or dizzy
• headaches
• fast breathing
• palpitations
• pins and needles
• increased feeling to urinate
• racing thoughts

As I was wiring this article, it struck me that whenever I would write a list such as the one above, for my assignments, I would usually label these as “symptoms”, demonstrating how ingrained the medical model is into our vocabulary.

For the record, I wish to state that whilst this article will seek to challenge the medical model, I am not against it per se, but rather am calling for a change in the way in which it seeks to inform and support people that are experiencing anxiety.

As a therapist who works with humans, it is unsurprising that many of my clients experience anxiety at varying degrees throughout their lives. What strikes me is that many of these people come to me with the understanding that they “have” anxiety or an anxiety “disorder”. They usually follow this up by telling me that their GP had diagnosed them with anxiety when they described their symptoms.

I have also come to expect that they will go on to tell me that their GP recommended medication as a first response, even though research generally suggests that psychotherapy is a more effective treatment for anxiety disorders.

It is my belief that the language used within the medical model can have a detrimental effect on the person experiencing anxiety. For instance, when a person is told that they ‘have’ something, rather than that they are experiencing it.

Anxiety is normal. Generally speaking, all humans experience anxiety and as previously discussed, it is an innate biological response to threat. We would not wish away anxiety. It keeps us safe and we need it for our very survival, but what should we do when our alarm system seems ‘out of whack’?

Whilst this alarm system is specifically engineered for our survival, it is a very old system in the brain that has not evolved to include the daily stresses and strains of living in the modern world.

Our brain can not recognise that if we don’t get that paper in by Monday, the worst thing to happen is that we fail the course, instead our threat system (acting in service of our survival) believes this to be a life or death situation and acts in accordance; proving our body with those lovely hormones that allow us to stand and fight or run for our lives.

For this reason, many people struggle with anxiety that is (seemingly) disproportionate to the actual threat. When anxiety feels out of control, it is important for people to seek professional advice and support to help them learn the tools to soothe their nervous system back to a baseline level of anxiety.  

In recent years, there has been a shift in the way in which mental health has been spoken about. There is more awareness of anxiety and the way in which it can show up. Whilst this is a positive step forward in helping people to better understand their mental health and when they need to seek help, a shortfall of this movement is that people may over-identify with their very normal feelings of anxiety; viewing their anxiety as pathological.

This is further reinforced by the medical model creating a self-fulfilling prophecy: I experience feelings of anxiety, I begin to worry about my feelings of anxiety, this causes me further anxiety and as such begins a vicious cycle.

If we perceive anxiety as something that is outside of our control, we may start to develop feelings of hopelessness, powerlessness and desperation, all of which can lead the person into a place of deep despair.

The main argument here is that by using psycho-education, GPs and other health care professionals can aid people in better understanding the function of their anxiety, and for some feelings of anxiety to be more normalised as a part of the human experience.

Further to this argument is the notion that GPs should be empowering people and giving them agency around their treatment choices; many of my clients have reported that they were not given a range of options when they sought support from their GP. They were generally given a prescription for anti-anxiety or anti-depression medication and very little else.

Clients should be made away of the range of treatments available to them and be informed of the benefits and consequences of all treatment options. It can also be argued that even within talk therapies there is a bias for GPs (and other health care professionals) to recommend cognitive behavioural therapy (CBT) as the gold standard treatment for anxiety. Whilst CBT has a wealth of empirical evidence and its effectiveness can not be understated, it is clear that not all people will respond in the same way to the same treatment.

There are a wide range of therapy options for those experiencing anxiety and it should be encouraged that people seek support that is the best option for them. For this reason, I argue that healthcare professionals should be reevaluating how they manage treatment for people experiencing anxiety.

GPs should be signposting people to self-help resources, psycho-educational resources, talk therapists and holistic methods. Implementing a bio-psycho-social model in the understanding of anxiety before prescribing medication or pathologising perfectly normal and human responses to stress.

Talk therapy (along with other types of psychotherapy) can be useful in helping people to practice the art of detachment from anxiety. It can help people to understand the root cause of their anxiety and what you may be responding to. It can also help people to normalise their experiences and understand the function of their anxiety.

Overall, anxiety can be described as the brain’s alarm system, responsible for detecting threats in the environment and forcing the body to react in a way that keeps us safe and as such, some degree of anxiety is normal in all humans. However, anxiety becomes out of control when we react to situations that are not life-threatening as if they were. This can lead to a number of physiological and physiological problems and requires people to seek support.

This article argues that the support that people receive when they do seek help, needs to be more person-centred. GPs must move away from pathologising normal human experiences and using medication as a first-line response. Anxiety is there for a very good reason and can often be managed through self-care, more adaptive coping strategies and a better understanding of the neuroscience of anxiety and its function.