Mental Illness – Parts Per Billion

Anxiety – Ugly (But Precious) Gift From Evolution

Anxiety serves to prepare a person for threats. Anxiety just like pain is one uncomfortable but effective way to cope up with the adversities in life, that’s how we build strength, resistance and deeper understanding of the surrounding for better and more precisely predictable future.
The remarkable concepts like smoke detector principal and optimal threshold in signal detection theory developed by modern psychologists/ psychiatrists help us to draw a line between a healthy anxiety (adaptive function) and unhealthy anxiety (pathology) and show ways to handle/treat them effectively.

Anxiety’s like a rocking chair. It gives you something to do, but it doesn’t get you very far
Jodi Picoult

Survival, Fear, and Anxiety

Every living thing if not have any goal in their lifetime would at least have sole goal of existing, surviving. Nobody wants to die and all of us always yearn to live forever but we know our limitations and hence are always on the quest of justifying the finite existence granted to us. Even if we are certain of the end closing in, our instincts are evolved in such way that many of the times, we bear the ability to cheat death. Humans have further extended cheating the death using science and technology. Technology augmented our lives, reduced the risks of death, created a safe environment to grow, increased our chances of survival.

The fear of death and uncertainty of future is the key driver in our improved survival instincts and excessive use of technology to achieve it. We plan for things in advance, create backup plans if something would go wrong, have risk assessments before the execution, understand and decide according to the cost benefit analysis. That is what makes us humans and also separates from other species (although rest of the surviving species are also smart in their own ways to increase their chances of survival like viruses – but hopefully humans have other ways to overcome them)

So, fear in a way triggers the actions to ensure survival. Anxiety – a sophisticated form of fear which prepares us in advance even before the fear causing scenario is supposed to happen. Simply put anxiety is an anticipatory type of fear to increase the chances of survival.

I am talking about fear and anxiety because they are bugging my mind for many days. Recently I watched Inside Out 2 movie and the it really delivers. The narrative has successfully presented how all emotions play a vital role in creating our personality in whole. Anxiety was new and important emotion presented in this movie. Every moment where anxiety came in focus it was fully relatable to me. Once I was done crying in the end the anxiety never left me (figuratively!), I felt a strong urge to understand the anxiety on deeper levels and what the domain experts have to say about anxiety.

The discussion heron is not a movie review rather I have made some attempt to summarize what the real-world scientists have to say about anxiety. I won’t be giving you the tricks, counseling and recommending any medicines to cure anxiety disorders. (Trained professional, experts are the best people to do that – “I AM NO EXPERT”)

My focus of the discussion is to question why anxiety exists in first place when we have an emotion called fear, another question is how to interpret the anxious emotions and what leads to anxiety disorder, where does the root of anxiety lie and is anxiety a bad or negative emotion? If it is so then why? and if not – then why?

While posing such questions and researching articles I came across some beautiful ideas, experiments and theories established by professionals in the field. I will throw light on these ideas in the coming discussion.

The fear is real! – is it? – Defining anxiety

As I already mentioned that fear of death, the unknown and urge to live long are always fighting with each other. Humans rather every species existing today in nature mastered this battle to some extent and have ridden on chariots of evolution to augment – change themselves to adapt with the surroundings and improve the chances of survival.

A deer completely aware of its surrounding, grazing in the open grass fields can distinguish the rusting of leaves due to winds and rustling due to sudden movements of an apex predator like tiger. When the exams are on top of tomorrow, we are ready to sacrifice the night sleep to crack them (engineers would resonate more with this!) We know that the pain of failing, fear of failing is worse than painfully covering syllabus overnight! The fear is there and the anticipatory response is also there, only the level of sophistication is different.

Why I say sophistication? It is because due to the advancements in our lifestyles humans are rarely exposed to the real life-threatening scenarios like animal do (still today). Our fears are now more anticipatory. I would say most of our fears are now classified as anxiety.

Wikipedia goes like this for anxiety –

“Anxiety is an emotion which is characterized by an unpleasant state of inner turmoil and includes feelings of dread over anticipated events.”

So, the key differentiating aspect between fear and anxiety is the anticipation. Anxiety is a prospective emotion and a forward-looking emotion. Whereas fear is the emotional response to current threat. Fear makes us act immediately; anxiety keeps us ready for future threats. Fear will immediately decide fight or flight whereas anxiety will create plans, strategies for both and also calculate which one is more probable. (now you can appreciate why anxiety is more intense in over-thinkers, the analysis paralysis is one mild example of this.)

Anxiety is also an emotion important from evolutionary perspective as it has helped the current existing species to remain existent. The ability to anticipate future and preparing for it in advance gives competitive edge in survival.

Why Is Anxiety Good?

While reading about anxiety I came across a very good paper by Dr. Randolph M. Nesse.

Randolph M. Nesse is a Professor Emeritus of Psychiatry and Psychology in University of Michigan. The ideas and theory he created to understand and identify anxiety and its intensity are very important and interesting.

Dr. Ness developed the smoke detector principle to control and quantify the medication used to fight with anxiety disorder. (He poses very simple but important question the opening of the paper that “Is he medicating his patients too much? is he harming them?”) The fundamental doubt Dr. Ness had was if the anxiety is evolved during evolution to improve our chances of survival, then why are we forced to reduce its symptoms and effects? Why are we using medications, therapies to reduce these symptoms, effects of anxiety. What if the patient is too anxious for given thing and that thing is too real to happen but the doctor dumbed that emotion down? (Dr. Ness calls it down-regulating the mechanisms causing anxiety)

The core of his thinking is that if we keep on “down-regulating” our anxiety which is an evolutionary gift to us, we might never be able to gauge the future in better way and prepare for it in advance to improve our chances of survival. (this is an exaggeration of the scenario but it proves a point)

This calls for the quantification of anxiety. Which Dr. Ness did through the smoke detector principle.

The Smoke Detector Principle – How Much Anxiety Is Too Much?

Dr. Ness in another paper talks about the mechanism which is a feed-back system between the animal and its surroundings, which selects the emotional response to improve the chances of survival. The emotions we have today are the result of such evolution to maintain “homeostasis” – the balance among our bodily system to survive and function properly.

According to his ideas, anxiety works like a smoke detector.

The anxiety response is always trying to maximize the chances of survival and escape from a life-threatening situation. When we set a smoke detector it will go off even when the fire is not that extreme or if there is just some smoke which can be a controllable one. The smoke detector is designed to never miss a single fire causing situation. This ensures complete confidence in smoke detector that it will save people from every life taking fire scenario. But, it’s the same mechanism of smoke detector which forces people to evacuate frequently even when the fire or smoke where controllable or life threatening.

The frequent emergency evacuation even when it is not required is the same problem with the extreme intensity cases of anxiety. Always having armor ready for combat may sometimes make the soldier to lose the agility.

The patients with anxiety disorder have lowered sense of real threat. Their system triggers too many false alarms.

Dr. Ness established various techniques to quantify the levels of anxiety. The responses from anxiety include increased heart rate, rise in certain bodily chemicals – stress hormone secretion which can be easily measured as signals using instruments. Thus, the smoke detector principal paved a way to quantify the anxiety and understand what triggers the anxiety disorders in patients. It helps to understand how and why a level of anxiety is healthy in normal person and what level of anxiety is unhealthy and needs drug administration, therapy, how it can be administered by altering the setting within and around the person.

The core reasons why we need not to be intensely anxious about common life threats are as follows as Dr. Ness explains in his papers:

Regulatory mechanisms have tendency to make errors and be extra defensive about situations
We do not need to always be extra defensive to avoid given threat. (A machine gun in a bulletproof enclosure is not required to kill a mosquito.)
Our body and surroundings have multiple layers of defense for almost all common threats. We are evolved and have survived in that way.
Our environment is much safer than it was at the time we evolved

Types of Anxiety Disorders

Now that we have understood what is the nature of anxiety and what is its mechanism. Here are some important anxiety disorders to outline. Huge amount of information is available in literature, internet websites on these:

Generalized anxiety disorder (GAD) – too much worrying about ordinary things, problems like money, work, health, relations, family, and anything possible or imaginable, it may not exist in reality.
Hypochondriasis – People suffering from this often worry about the health condition when nothing is wrong with their body. The word comes from feeling of stomach pain the person experiences even when everything is alright.
Specific phobia – fear of anything but specific without any reason. It’s the fear for certain thing even when it does not pose threat.
Social anxiety disorder (SAD) – In this scenario people intensely fear the public situations, humiliations, embarrassments, criticisms.
Separation anxiety disorder (SepAD) – People in this case intensely fear the loss of person or a place
Agoraphobia – it is fear of being in situation where there is no exit door, or escape strategy. Fear of using public transportation, being in large crowds are some examples.
Panic disorder – these are outburst of all the collective or intensive fears, they come quickly and last for short time.
Selective mutism (SM) – in this case the person is extremely fearful of initiating a conversation, does not speak to specific people or in specific situations or conditions even when they are forced to talk by humiliation or mocking.

Post traumatic syndrome disorder (PTSD) and Obsessive-compulsive disorder (OCD) were once classified under anxiety disorders (now not under anxiety disorder in DSM – Diagnostic and Statistical Manual of mental disorders)

Signal Detection Theory For Interpreting ‘Anxiety Like Responses’

One good paper in the Canadian Journal of Psychiatry by Bateson et al. shows how the smoke detector principal can be used to decide the boundaries of different levels of “anxiety like-responses”. This paper talks about signal detection theory and optimal threshold. The beauty of this paper for me is the mathematical model it establishes to explain psychological events. A single formula will help you understand the difference between normal anxiety and anxiety disorder.

With the smoke detector principal, we can now appreciate that not every common threat needs full armored protection. The signal detection theory in this paper shows where a person draws line when they overestimate or underestimate anxiety.

It talks about “optimal threshold” to show a threat response in given situation. Optimal threshold is a mathematical parameter which is function of probability of the occurrence real event and vulnerability of the individual.

The signal detection theory says that the superposition of response signals for given background noise and response signal from real threat give us the quantified judgement of how intensely the anxiety is triggered compared to the practicality of the threat – this quantified judgement is called optimal threshold (λ). Lower the threshold more intensely the anxiety will be triggered for given disturbance – background noise.

Figure 1 : Signal detection problem, how the optimal threshold can be calculated. (Credit: Anxiety: An Evolutionary Approach, 2011, Bateson et al., Canadian Journal of Psychiatry)

Equation 1: optimum threshold (Credit: Anxiety: An Evolutionary Approach, 2011, Bateson et al.,Canadian Journal of Psychiatry)

Here,

λ = optimal threshold

p_nt= probability that there is no threat

p_t= probability that there is real threat

w_fa= cost of false alarm

w_miss = cost of a miss

Once this equation comes in focus the discussion becomes interesting. The ratio of p_nt to p_t mathematically quantifies how practical the threat is. The ratio of w_fa to w_miss mathematically quantifies what will be the cost if the anxiety trigger is accepted or rejected – will the subject live or die. This ratio shows how we trigger anxiety response. If the cost of responding is nothing for even a simple threat scenario, we will choose to trigger that response, same would happen if the cost of losing is ultimately the loss of life, we would trigger any possible anxiety response to avoid it. The authors call this ratio as individual’s vulnerability.

The ratio (p_nt/p_t) can be seen like this. If the surrounding really is hostile and consists of events which cause many life altering events than the safety ensuring events then the p_t (probability of threat) will be way higher than p_nt (probability of no threat and safer environment). In war situation where multiple bombings, gun firings are happening around you the probability of threat happening (p_t) is way high than it not happening (p_nt). The optimal threshold will drop immediately and anxiety triggered will be very high.

The ratio (w_fa / w_miss) can be seen like this. If the person is way stronger to handle given threat, then the person will need no effort, investment or cost to trigger any reaction alarm to even a false threat. Consider the example where you are about to be bit by mosquito, you know the efforts to slap many times until the mosquito dies are not worthless, you will try many times to kill it even when you know it will swiftly escape, you are less vulnerable in this scenario. But now when you are about to be killed by John Wick (!?) you know for sure that even a pencil will do the job for him, any environment is hostile for you, you are vulnerable here, the value of losing life (w_miss)is way high than the cost of attempts to save it (w_fa). Your optimal threshold will immediately drop down thus triggering intense anxiety.

Once you generate enough data for such optimal frequencies you can easily distinguish the healthy anxiety responses and anxiety disorders. I loved how these two factors (probability of threat and vulnerability of an individual) can predict the levels of anxiety in a person. This equation explains and can also quantify why pregnant women have heightened awareness of their surroundings, why people get insomniac after constant mental stress, why restless people are always in the mode of action and fight, why reclusive people hesitate to visit foreign, unknown places.

Your Surroundings and Mindset Matter!

Figure 2 : Three levels of vulnerability, here optimal threshold and probability of event can be correlated for difference in the anxiety responses (Credit: Anxiety: An Evolutionary Approach, 2011, Bateson et al., Canadian Journal of Psychiatry)

It is really interesting what the authors have achieved and established in this research. They compared three different levels of vulnerability and explained them using given plot. The thing to highlight here for anxiety disorders is that they emerge from the environments which always keep on presenting high probabilistic practically threatening scenarios. The anxiety disorders also emerge when the individual feels more vulnerable.

Higher the vulnerability lower will be the optimal threshold and intense will be the anxiety response.

As shown in research, in the uncertain times of Covid-19 people who were locked in their home had no disorders, were not exposed to the virus also felt anxious and faced some anxiety disorders because of the environment they were in.

If the person feels less vulnerable and stronger then even for given strong life-threatening events the optimal threshold will be higher thus the anxiety triggered will be lower.

Are you noticing where this is going?

This is a mathematical model which shows how a healthy, supportive, and safe environment and also a strong mindset and better judgment of reality is important for handling challenging situations.

For a person suffering from anxiety disorder, it becomes very important to make sure that they know that they are in a safer environment and are cared for. It is very important to make them feel safe and understood. Creating a system of critical thinking and reasoning can also help the person to have a sense of strength and high resistance to vulnerability, this also goes for physical strength. The vulnerability is not only mental it is also physical when it comes to reality.

You will now appreciate why teenagers and trauma patients are more exposed to anxiety disorders. Mostly and generally in teenagers it is due to the uncertainty of many new things happening with them simultaneously and in trauma patients it’s the constant bombardment of life-threatening events in hostile environments.

Conclusion

Anxiety serves to prepare a person for threats. The emotion called anxiety is an evolutionary gift to ensure long survival of our species but as it is also related to our primitive instincts, we mostly let anxiety overpower other emotions in seemingly safer scenarios. Strategy and anticipation are the gifts of anxiety but if overused they will end up in imparting unnecessary caution and overprotective attitude which inhibits adaptation to changes there by slowing evolution of our species. Anxiety just like pain is one uncomfortable but effective way to cope up with the adversities in life, that’s how we build strength, resistance and deeper understanding of the surrounding for better and more precisely predictable future.

The remarkable concepts like smoke detector principal and optimal threshold in signal detection theory developed by modern psychologists/ psychiatrists help us to draw a line between a healthy anxiety (adaptive function) and unhealthy anxiety (pathology) and ways to handle/ treat them effectively.

These theories show how we can quantify seemingly intangible emotions like anxiety and way to handle them. If you can measure something effectively you can control and predict it effectively. All credit goes to such brilliant minds!

References, Image sources and further reading:

Biases and Delusions – Steering on the borders of rationalism and insanity

Humans and the longing for eternal existence

There are these moments in many popular stories where our protagonist – the hero is feeling hopeless – depressed, is fed up by the cruelty, hardships, failures and some age-old character, a well-seasoned teacher or ‘that life altering event’ which give him the hope to continue against the antagonist – the villain of the story; obviously our hero wins. There are very common examples not only in pop culture, cinema but also in real human history and literature. It is very important to understanding that the qualities demonstrated in such exceptional times by our characters seems very illogical. (Remember the explanation of “The power of true love” or “the power of Hope” at the climax of your favorite movies, stories) In simple words, the reasons for such events are justified by the realization of something beyond the reality we experience, something supernatural – something which cannot be justified by a rational, logical thought. The explanation in these cases seems more spiritual and less practical or rational. Today we will see how one can differentiate between practical irrationalism (i.e., hope) and impractical irrationalism (i.e., delusion)

They say that “the death is the ultimate equalizer” which highlights how everyone of us considers their own existence as the most important part of our being. It is the most real and rational part which enables us to experience our life in reality. We are aware that all real and rational things are perishable, end-able and yet we are always making some attempts or at least thinking of prolonging our existence for eternity. This seems very irrational, impractical and still our mind always tries to falsify the thought that our life has an end somewhere. (We plan what we are going to eat/ wear/ do tomorrow, plan that trip, make new year resolutions even after the uncertain nature of our life and with the optimism/ hope that we will live to do those things as planned.)

Christopher Nolan’s Interstellar
The human urge to improvise, do something unconventional at the last moment of life is often epitome of all extreme survival stories. (Not only in movies but also in reality)

Our basic survival instincts are always aware of the chances and ways in which we can die. A healthy person’s subconscious mind is aware of the death and its consequences. Our immediate involuntary responses to life threatening events are examples of that. (You immediately remove your hand from a very hot thing because you know that it is going to hurt you.)

Interesting is when these such feeling for the longing of survival gets highlighted in some extreme and abnormal conditions. The conditions which are not generally faced by normal human beings.

Victor Frankl and The Delusion of Reprieve

Victor Frankl an Austrian neurologist and psychiatrist in his days in Auschwitz observed a very extreme and irrational behavior amongst the victims including himself. When the newly admitted Jewish prisoners were torn off of their own identities, the only thing they were left with was their hope for surviving through the tortures wishing that they have some things to finish, some purpose of life to fulfill after living through that real-life hell. Frankl in his book “Man’s Search for Meaning” creates a lively and horrifying picture of what a living hell looks like. Not even the greatest empath in the humanity can relate with the pain that these prisoners went through.

Frankl in this book explained the whole process when the Jewish prisoners were admitted to the concentration camp. At first, the prisoners went through the shock that they were being taken to Auschwitz – a place infamous for ruthless deaths of Jewish people. Then the hostility of a deserted, dry, barren land maintained by people with similar dried emotions amplifies that shock.

In this exact moment, Frankl noticed a group of people who looked much healthier and with some wit/ humor which highlighted the sanity of their minds even in such hostile environments; maintaining that snobby “attitude” even in this deserted, unfriendly environment was one relief for him.

With this observation, Frankl concluded that he too will be able to match with these people in order to survive through this hell with relatively lesser pain. One has to understand that this urge to have a lesser painful life in Auschwitz was not even closer to the reality, even the word “exception” would fall short for this. And still, even after knowing the fact that there is no escape from this hell, even after knowing that almost all of the people in Auschwitz die from inhumane mental and physical tortures, hard labor, starvation, diseases, internal disputes, favor-ism, unfairness, Frankl thought that there is a chance that he can climb up this ladder and become part of this “snob party”. One has to understand that the thoughts Frankl is having here are totally irrational. Frankl was already aware of the consequences of being sent to Auschwitz but even after that his mind chooses an irrational idea of facing less pain in Auschwitz. Frankl justifies this irrationalism by the “inborn optimism in him” and calls this condition in psychiatry as “delusion of reprieve”. He explains this in following words:

“The condemned man, immediately before his execution, gets the illusion that he might be reprieved at the very last minute. We, too, clung to shreds of hope and believed to the last moment that it would not be so bad.”

This “delusion” of being “pardoned” at the very last moment becomes the very first stage in the psychosis (a mental disorder of getting detached from the reality) of the people exposed to extreme ruthless environments of Auschwitz. This is totally different from the stories of conventional heroes and villains. Here, the person has completely lost the sense of what is a real possibility and what is an unrealistic demand. The conscience – ‘mere rational’ of the person gets broken in the hope that there is still something good and some chance of survival through this.

Biases, Delusions and Apathy

In psychology the biases and delusions are closely connected and highlight the tipping point from where the psychosis starts. First of all, it is very important to know that we all have biases. Biases are our favored, prejudiced opinions for someone or something. Biases are some sort of mental shortcuts to avoid the energy loss for processing huge amount of information. Here are some examples of cognitive biases (a systematic pattern of deviation from norm or rationality in judgment):

Availability Heuristic Bias – People do not make decisions based on the data and statistics but on the stories and the stuff they hear from other people. You would want to easily trust what news show than to actually check and cross check fact with real data.

Choice Supportive Bias – People defend themselves because it was their choice. Because, if they made the choice, it must be right. You could be never wrong because you feel so is common scenario. Remember the time when you don’t even care to google what you just assume to be right because you think so.

Confirmation Bias – We tend to listen to information that confirms what we already know. Even after knowing that you were wrong you support and believe only that information that proves your thinking. Remember the flat earth conspiracy?

Ostrich Bias – Subconscious decision to ignore the negative information. Remember (again) the flat earth controversy?

Placebo Bias – Belief will help you recover. Loosely speaking, it can be explained by the idea of fake it until you make it. Your mind will make decisions based on the illusion that you are rich thereby ultimately making you rich. Placebo drug therapy is also the best example (but repeated words won’t explain the meaning)

There are many types of cognitive biases which actually throw light on our belief systems. (This could be a good discussion for some other times). The point is that when such biases start having a strong hold on a person’s mind, the person becomes delusional, leading to delusional disorders. This is triggered by some abnormal and unexpected situations. Victor Frankl actually observed and even went through such experiences where he establishes the “emotional death” of a person.

Due to constant shocks and bombardment of unconventional cruel treatments, the mind of person becomes numb to the extremities of the experiences and their response to such cruel, extreme and abnormal things no longer remains reactive as if these are normal situations for them. This is the “emotional death” Frankl is referring to. They became detached from the reality and thereby the humane emotions and responses to the cruelty around them – they became apathetic. Neither positive nor negative emotions.

Fine line between biases and delusions

Carrying the hope of having some moments of escape is also one example of the biased thinking the prisoners carried. Even after knowing, seeing and experiencing the cruelty in Auschwitz, their minds were not ready to accept the reality that it is close to impossible to escape this hell. Frankl’s well explained ‘delusional behavior among prisoners’ is one important part of Humanistic Psychology and Cognitive Behavioral Therapy.

Delusion disorder are classified as Bizarre (realistically impossible) and non-bizarre (possible but wrong in nature). Jumping to conclusion bias is one of the most researched bias connecting to delusional disorders.

Jumping to Conclusion Bias (JTC Bias) – A bias where something is assumed to be true without collecting all the information/ data. It is also known as inference-observation confusion.

You can find in Frankl’s description of their admission in Auschwitz where he explained “those” healthier group of people. The optimistic urge of Frankl to be in level with them is an example of jumping to conclusion bias. With very little information and an unrealistic urge to survive Frankl unknowingly became victim to the delusion. (Although his profession helped him to distinguish such behaviors and work over them leading to strengthening and establishment of Logotherapy) There are some studies which have also highlighted that jumping to conclusion is one of the biases closely related to delusions and psychosis but it not the only reason, rather it is very unclear that how delusions form. Studies show that there are two possible reasons to why JTC Bias and delusions are closely related. One is “the intolerance of uncertainty” and second is the “impaired working memory”. In simple words, firstly – the fear of unknown, ambiguity in the outcomes of the things makes the mind to take shortcut and create a simple conclusion to settle the chaos of the data (which already is limited) thereby making an unrealistic expectation from the event and secondly the incapability of one’s memory to handle the routine tasks makes it impossible to derive conclusions from complete data thereby restricting the flow of information as minimum as possible to make the conclusion which then become unrealistic. These two reasons possibly indicate the connection between JTC and delusions. Please note that JTC is not the only bias which can cause delusions.

Although delusions are very extreme part of human psyche, it is very interesting to understand their link with the biases almost every human being has. Given that such types of biases are always there within us representing some short-lived illusions from truth or I would say “quasi-delusions”, it becomes very important to notice such patterns and immediately work over them. Being mindful, being aware of the thoughts we are having and the coherence of the conclusion we are drawing from them is one of the most important way to remain free from the biases and delusions.

The Metacognition therapy, the logotherapy thus are the important branches in humanistic psychology which contributed in this field. The psychology of hope is also one important aspect of delusions related to survival; especially in the cases resembling to Viktor Frankl’s experiences.

References and Further Reading: