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Helen is an Associate Lecturer teaching on modules in years 1 and 3.
I wear several hats in life, but I write this blog in the role of a lecturer and a psychologist, with experience in the theory and practice of working with people with psychological disorders.
In recent years, there has been an increase in awareness of mental health problems. This is very welcome. Celebrities have talked openly about their own difficulties and high profile campaigns encourage us to bring mental health problems out of the shadows. This is hugely beneficial. When people with mental health problems suffer in silence their suffering is invariably increased, and simply talking and being listened to is often the most important part of the solution.
But with such increased awareness, there can also be well-intentioned but misguided responses which make things worse. I want to talk particularly about anxiety (which is sometimes lumped together with depression to give a diagnosis of “anxiety and depression” – they can and do often occur together but they are different emotions which require different responses). Anxiety is a normal emotion which we all experience. It is essential for survival. It keeps us safe. If children did not experience anxiety, they would wander away from their parents, put their hands in fires, fall off high surfaces or get run over by cars. Low levels of anxiety are associated with dangerous behaviour and psychopathy. High levels of anxiety can, of course, be extremely distressing and debilitating. People with anxiety disorders avoid the things they fear to the point where their lives become smaller and smaller and their experience severely restricted.
Of course we should show compassion and understanding to people who suffer from anxiety disorders and some campaigners have suggested that mental health problems should receive the same sort of response as physical health problems. However, psychological disorders, including anxiety disorders, do not behave like physical illnesses. It is not a case of diagnosing a particular “bug” and then prescribing the appropriate medication or therapy to make it go away (in reality, many physical conditions do not behave like this either). Anxiety thrives when you feed it. The temptation when you suffer high levels of anxiety is to avoid the thing that makes you anxious. But anyone who has sat through my lecture on learning theory should remember that doing something that relieves or avoids a negative consequence leads to negative reinforcement. If you avoid something that makes you highly anxious (or do something that temporarily relieves the anxiety, such as repeatedly washing your hands, or engaging in a ritual) the avoidance behaviour will be strongly reinforced. And you never experience the target of your fears, so you never learn that nothing catastrophic is actually going to happen – in other words you prevent the “extinction” that would otherwise occur. So the anxiety just gets worse and worse and worse. And your life becomes more and more restricted.
So, while we should, of course be compassionate and supportive towards people with anxiety disorders, we should be careful not to feed their fears. I remember once becoming frustrated with a member of prison staff who proudly told me how she was supporting a prisoner with obsessive-compulsive disorder by allowing him to have extra cleaning materials. No! In doing so, she was facilitating his disorder. What he needed was support to tolerate a less than spotless cell, so that he could learn through experience that a small amount of dirt does not lead to disaster. Increasingly, we find ourselves teaching students with anxiety difficulties. We need to support and encourage them, to allow them to talk about their problems, and to ensure that their university experience is positive. But we do them no favours by removing challenges or allowing them to avoid the aspects of university life that they fear (such as giving presentations or working in groups). In doing so, we make life easier in the short-term, but in the long-term we feed their disorders and make things worse. As I said earlier, we all experience anxiety and the best way to prevent it from controlling us is to stare it in the face and get on with whatever life throws at us.