We’ve Made So Much Progress Talking About Depression. Why Isn’t The Same True For Anxiety?

In November we held our first youth unconference, JUNKET. Over the coming weeks we’re sharing thoughts and features from some of our 200 delegates on the topics they raised. This, from Benjamin Riley, leads on from a discussion about anxiety.

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I’ve had moderate to severe problems with anxiety for most of my adult life.

Most of my anxiety manifests around how I spend my time. Weekends are the worst—I spend the week looking forward to a stretch of time in which I can do all the things I think I need to get done, then suddenly it’s Sunday afternoon and I’m hating myself for not ticking any items off my endless to-do lists. Instead I’ve inevitably spent the weekend distracting myself, because it’s easier than acknowledging the crushing weight of my own expectations.

For similar reasons, I’m late to everything because I avoid getting ready until the last minute. Eventually I lie to my friends about when I’m going to arrive, and then lie again about why I’m late. I tell the first lie because I want to hold on to the illusion of a moment in which I am on top of things. I tell the second lie because I am so deeply ashamed of the reality that I am not.

I’ve been medicated for anxiety on and off, and I see a counsellor regularly. Both things have, at times, helped.

I don’t write this to torture myself (or, I hope, you) I do it because until recently I’d thought I was the only person who lived like this.

When the ABC ran a week of programming on mental health called ‘Mental As’ back in October, I looked for myself in the content and found nothing. There were plenty of personal accounts aired throughout the week, but most seemed to be stories of depression and suicide. When ‘mental health’ was talked about in general terms, again it seemed to be code for depression.

It’s worth bearing in mind that even 20 years ago, we didn’t really talk about mental health at all in Australia, depression or otherwise. A proliferation of mental health organisations over the past decade or so has brought with it greater recognition of depression as a mental illness, making a real difference to the lives of many.

But if we’ve made so much progress on representing and talking about depression, why haven’t we done the same when it comes to anxiety? Why, when according to ABS data, within a 12-month period more than twice as many Australians had experienced anxiety compared with depression?

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Baby Steps: Getting People’s Heads Around Mental Illness

For many, much of the credit for the astonishing progress on recognising depression goes to Beyondblue. What began as the ‘national depression initiative’ in 2000 has only expanded to include anxiety in the last few years—given its dubious status as Australia’s most commonly diagnosed mental health condition, I wanted to know why anxiety came second.

Stephen Carbone is Beyondblue’s policy, research and evaluation leader, and he told me that when the organisation was founded, depression was seen as an easy place to start. As far as engaging the general public, anxiety was considered comparatively complex.

“Anxiety is tricky because it’s really a cluster of conditions rather than a condition in its own right… simple phobias, social phobias, panic disorder, generalised anxiety disorder, and back then it was also OCD and PTSD,” said Carbone.

“Yes there’s different types of depression to a degree, but it was a little bit more coherent and able to be explained. Obviously people understood that, they’d seen people [with depression] themselves, it was a common condition, they could ‘get it’.”

The other major motivating factor for starting with depression was its link with suicide.

Carbone said looking at depression seemed like a way to bring down suicide rates: “There was a feeling like, if people knew more about these conditions, maybe they would prepared to come forward if they were concerned, or if they were concerned about others, maybe that would be a way to bring down our suicide rates.”

So Beyondblue got to work raising awareness of depression, and apparently the plan was always to move on to other conditions once significant traction had been gained. However, that process took more than a decade. Carbone said he hopes anxiety won’t take as long, and assured me there were already early signs of progress.

I couldn’t help but be a bit sceptical of the idea that we still aren’t really talking about anxiety because ‘Beyondblue just hadn’t got around to it’. I asked Carbone about this, and while he acknowledged the role of the many other mental health organisations working in Australia, his response didn’t really change.

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Mental Health and ‘Productivity’: The Cost Of Counting The Cost

When I look at my own experience, I think part of the reason I’m able to keep my anxiety hidden is that even when it is quite severe I can, for all visible intents and purposes, still function. I can get up, I can go to work, I can even be, to some degree, productive.

In fact, ‘productivity’ is increasingly being talked about in relation to mental health, as more and more research bodies release reports that attempt to estimate the cost of mental illness to the Australian economy. These ‘cost of illness’ reports attach dollar values to, most commonly, days taken off work due to mental illness, and decreased productivity in the workplace due to mental illness. When so many of the symptoms of anxiety disorders can be positively associated with a ‘productive’ work life, it presents an obvious problem for anxiety to be taken seriously, or even identified at all within a work environment.

“We talk about things like ‘perfectionism’, perfectionism is just anxiety—it means you are highly anxious about having something that is perfect,” said Jane Burns, CEO of the Young and Well Cooperative Research Centre.

“Some people it works well for—they are extremely high performers, and there’s no doubt about that, but… there is absolutely no doubt in my mind that there are many, many anxious [people], perhaps not diagnosed people with anxiety, who are perfectionists in workplaces and who are pressure time bombs waiting to go off.”

Burns, who has decades of experience in young people’s mental health, was at Beyondblue when it first started, heading up the organisation’s youth response.

She agreed with Stephen Carbone that depression was probably the focus early on because it’s easier to see than anxiety: “There’s still a lot of stigma attached to depression, but people when they talk about anxiety tend to treat it as though it’s, ‘I’m feeling a bit anxious.’ So it’s suddenly become a bit of an expression rather than an actual illness.”

Despite where I started with this, I tend to be a bit cynical about questions of representation. I worry that getting too stuck in a conversation about changing the way things look can prevent us from pushing for more direct, material interventions. The same criticisms were levelled at the ABC during ‘Mental As’ week by commentators whose views align fairly closely with my own position on the issue: we don’t need awareness-raising, we need a better—and better funded—mental health system. Interestingly, Beyondblue has copped similar flak over the years.

But over the past month or so, as I’ve been making an effort to be more open and honest about my anxiety, I’ve wondered whether I’ve been too dismissive of the how damaging it has been for me not to see that other people were having similar experiences.

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The Importance And The Limits of Openness

In fact, my desire to write something about my anxiety came out of attending Junket, Junkee’s ‘unconference’ in Canberra last month. On the final day, former Junkee editor Steph Harmon stood up in front of the 200 delegates and acknowledged that she’d struggled with anxiety throughout the event. She suggested that, in a room full of high-achievers, she probably wasn’t alone. And, of course, she wasn’t.

My own attempts at openness have sparked conversations with friends (unsurprisingly, often high-achieving friends) I had no idea were dealing with sometimes quite severe anxiety. In one instance, sharing my own history of anxiety led to me and a friend discussing how long we go without replying to text messages. She understood when I said that every time my phone buzzes with a text or a Facebook message or an email it’s a reminder not just of something else I now have to do, but of the person on the other end who I’ll inevitably end up disappointing when I avoid replying for days, weeks or months.

Those moments feel important. In trying to acknowledge the profound shame I feel around my anxiety I have started to recognise how valuable it is see my experience reflected in other people.

But those moments feel important only right up until they butt up against what it actually means to live — and, perhaps more importantly, work — in the world. In reality, for all good intentions most employers are unable or unwilling to make the kinds of changes actually required to support people living with mental illness. More than that, many of the outward manifestations of anxiety, like perfectionism, a general level of over-functioning, even stress, are actively encouraged or even celebrated within many workplaces.

I asked Jane Burns from Young and Well if she thought there was a tension between on the one hand, using productivity and participation in the workforce as a measure of mental health, and on the other, the fact that for many people living with anxiety, the workplace is a source of that anxiety. She admitted that her own organisation, despite working in mental health, struggled to implement its well-meaning policies put in place to support the wellbeing of its staff.

“When you’re under the pump you’re sort of just under the pump and you go well, we’ve all just got to get in and get it done—that’s not a particularly great workplace for someone who lives with anxiety,” Burns told me.

“I look at some of the more traditional workplaces, there’s a real question around, can they actually support workers to work in an environment that’s good for their mental health? Is it even possible in the way society’s set up at the moment? Lawyers, doctors, paramedics, they come straight into high-pressure, high-stress jobs, and people are really not coping well with it.”

While I agreed with Burns, it was still a little confronting to hear the head of a mental health organisation admit that what’s required for people living with anxiety to be more supported is potentially a complete re-thinking of our labour market, to end the long hours, the constant deadlines, the widespread lack of flexible working conditions. Or maybe at the softer end of reform, some honesty from employers that basic awareness-raising initiatives around mental health in the workplace (Mental Health First Aid and R U OK spring to mind) aren’t good enough.

“I actually think we’ve done ourselves a disservice by thinking that teaching people about the signs and symptoms of depression, and to a lesser degree anxiety, was actually going to change people’s behaviours, and to think that sort of education was going to ensure people got help for whatever was going on for them,” Burns said.

“It’s kind of like a tick-the-box, oh we’ve done mental health first aid but we’ve got a workforce that works ridiculously long hours, and a workforce that is continually under pressure, we’ve got a workforce that’s not supported.”

I hope that Stephen Carbone is right; that the early work of Beyondblue and other mental health organisations is just the beginning of some genuine change around how we recognise and talk about anxiety. If my own experience is any indication, there’s immense value in finding out you’re not alone.

But I can’t stop thinking about Carbone’s argument that the challenge will be to help explain the distinction between ‘normal’ responses to stressful situations, and what become ‘anxiety conditions’. I worry that when the workforce valorises our ability to handle stressful situations, those ‘normal’ responses to stress become, well, the norm.

And I worry too that talking about anxiety forces us to brush up against the limits of our current framework for engaging with mental health in Australia, perhaps in a way that depression does not. If it’s sustainable for people living with anxiety to continue participating in a workforce that fuels that anxiety, real change will require much more than awareness.

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If you suffer from depression or anxiety, you can reach Lifeline on 13 11 14, or beyondblue on 1300 22 4636.

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Benjamin Riley is a Melbourne-based journalist working in gay men’s health and writing mostly about queer politics and culture. Follow him on Twitter at @bencriley