Or is the answer, “none of the above”?
Hi Dr. Burns,
In your When Panic Attacks book you are saying that anxiety is mostly the problem of kind and nice people (or extremely kind and nice). So my question is what happened to the kind people in the last century?
We know anxiety disorders increased by that time, right? So is it the technology and increasing social withdrawal, is it increasing struggle for jobs, is it the decreasing quality of our diets (less vitamins, hormones and minerals).
Thanks for your kind answer.
You always ask cool questions. How about “none of the above” for an answer. There are really two related questions: 1. Do we have any valid information that rates of depression or anxiety are changing? 2. Do we have any valid information about environmental or biological factors that might account these changes?
With regard to the first question, I do not know of any valid historical information on changes in the rate of depression or anxiety in the past 50 or 100 years or more. To study rates of change, you first have to have valid measurement devices. My own depression and anxiety inventories are brief and reasonably good, with reliability coefficients (accuracy) around 95%. But they were only developed recently. The Beck Depression Inventory was the first depression test, and it was published in 1964, I believe. It’s reliability coefficient is lower, around 80% or less, but it was important historically because it showed that mysterious concepts like anxiety or depression can, in fact, be measured with reasonably high precision.
So before we get too fancy about interpreting changes in rates of various emotional problems, such as anxiety, we first need to get the evidence that the rates are, in fact, changing! But I’ve never seen any evidence, and in fact, this would be impossible without the administration of accurate anxiety tests to large populations repeatedly over time. I am not aware of any studies of that type. And my hunch is that depression and anxiety have been human afflictions for a long time, and were probably just as common hundreds, thousands, or even tens of thousands of years ago.
With regard to the second question, you wondered whether anxiety results from changes in technology, unemployment, or by the quality of the food we eat. The causes of all psychiatric disorders are still pretty much unknown. I am not aware of any valid or convincing evidence linking anxiety to technology, employment, diet, hormones or minerals. However, this doesn’t stop people from assuming these factors are real and valid. I think the only thing we can say for sure is that all, or nearly all, current or historical theories about the psychological and biological causes of emotional distress can be shown to be false.
Probably the most we can say right now is that genetic factors are likely to be very important, along with environmental factors as well. But that’s not saying much!
I guess for many people, a wrong theory is better than none at all. or they assume that because something appeals to them, or seems to made sense, it must be true. Sometimes people believe what they want to believe, without much concern for critical, skeptical thinking, valid research, or truth. Before scientists discovered the causes of disorders like polio or epilepsy, there were dozens of false claims about the causes of these afflictions, and many quack treatments as well.
My focus is not so much on the causes of things, but simply on the development of high-speed techniques to help people recover, without waiting for the causes of depression and anxiety to be discovered! We can now measure changes in depression and anxiety across single therapy sessions, and this is historically really important, in my opinion, and represents a major treatment breakthrough. I love psychotherapy, and it never ceases to blow my mind when I see someone suddenly recover from years or even decades of suffering, right before my eyes during a therapy session!
The photo I sent with this blog if from a recent Sunday hike. On the Sunday hike this week, I worked with a young and extraordinarily dedicated and skillful physician who’d been experiencing intense depression, guilt, and inadequacy. He treats many patients with fatal and horrific illnesses that yet have no cure, and has been telling himself that he isn’t really helping his patients.
At the start of the hike, he looked like he was carrying the weight of the world on his shoulders, and he described individuals and families he’d gotten very attached to, and then had to tell the son or father that they had just a few years to live due to some horrible disease for which there is no cure or treatment.
i worked with him, using TEAM-CBT, and toward the end the hike, his symptoms had vanished, and he was flooded with feelings of joy and relief. That’s what I like to see, and what warms my heart and motivates me. It is, for me, the greatest experience of all, to help someone escape from the suffering of anxiety, depression, and self-doubt. if people are interested, contact me and I can ask his permission to describe what was so helpful for him.
So that’s my focus–I am trying to bring about a revolution in treatment. And I’m trying to learn how to get the word out, as best I can, through my blogs and podcasts and books.
I’m sure my answer might not be very satisfying to you, Kerem, but I deeply appreciate your questions and the dialogue, so keep your questions and comments coming! And keep in mind that I am only expressing my own opinions, and that lots of others–many very intelligent experts, in fact–will strongly disagree with lots of my thinking!
If you are reading this blog on social media, I appreciate it! I would like to invite you to visit my website, http://www.FeelingGood.com, as well. There you will find a wealth of free goodies, including my Feeling Good blogs, my Feeling Good Podcasts with host, Dr. Fabrice Nye, and the Ask Dr. David blogs as well, along with announcements of upcoming workshops, and tons of resources for mental health professionals as well as patients!
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