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Failure to recognize these common disorders perpetuates suffering and wastes resources.

The brain – which controls the entire body with all its physical properties, needs, yearnings, thoughts, and emotions – is the only repository of pain, both physical and emotional; without brain there is no pain.  The stigmatizing term, Mental Illness, is a demeaning misnomer that modern science has rejected and replaced with the non-stigmatizing, medically accurate term, Brain Illness.  There are two types of Brain Illnesses, the anatomical – such as brain tumors, strokes, infections, seizures, dementias – which are visible to the eye and the neurochemical – such as migraine, depression, anxiety, panic – which are caused by invisible defects in brain chemistry and neuronal wiring.

Anxiety and Panic disorders are genetic, neurochemical diseases of the Locus Ceruleus, which is the alarm button of the human brain.  In a healthy brain, the Locus Ceruleus adjusts the amount of Adrenalin it secrets to the gravity of the danger perceived.  If there is fire, flood, storm, aggression, etc. the Locus Ceruleus reacts by secreting a proportionately large amount of Adrenalin, a life-saving reaction that alarms the individual causing a flight-or-fight response.  However, in a susceptible brain, the Locus Ceruleus secretes its Adrenalin in disproportionately large amounts for minimally alarming situations – such as exposure to new faces, places, or situations – and that is when Anxiety and Panic become manifest.  Indeed, Anxiety and Panic are disorders of Adrenalin excess and the clinical manifestations of Anxiety and Panic are nothing but the physical and emotional consequences of excessive brain Adrenalin.

The spectrum of Anxiety can be visualized as a continuum from Good Anxiety at one end to Bad Anxiety at the other.  Good Anxiety is necessary for an effective, stimulated life; a student who is not anxious about a test may not prepare as hard, a driver who is not vigilant may have more accidents, and a writer who does not carefully edit his work may make excessive mistakes.  Consequently – unlike Bad Anxiety, which diminishes performance and the quality of life – good Anxiety may be defined as that appropriate amount of brain Adrenalin that enhances quality and performance.

Clinically, Anxiety is a great mimicker that wears different masks in different individuals.  Those who may seem shy, avoidant, quiet, reclusive, and harbor great fear of public speaking may actually suffer from Social Anxiety, which normally begins in childhood and is the forerunner of adult Anxiety and Panic disorders.  Adults, who suffer from bad anxiety, may complain of rapid heart beats, shortness of breath, dizziness, insomnia, abdominal cramps, diarrhea, urine urgency and frequency, hand and voice tremor, skin rashes, fatigue, chest pain, body aches, flushing, poor concentration and memory, irritability, etc. and may see many sub-specialists such as cardiologists, pulmonologists, neurologists, gastroenterologists, dermatologists, urologists, rheumatologists, etc.  They may become hypochondriacs, going from one sub-specialist to another and finding out with consternation that treating their individual symptoms does not improve their wellbeing.  Undiagnosed Anxiety victims overuse medical services, lose faith in the medical profession, visit charlatans and quacks, take excessive amounts of vitamins, minerals, and herbs, become delusional, and live a life of alarmed frustration.

Panic disorder victims are a lot worse off because on top of their daily Anxiety, they experience sudden attacks of panic, which make them feel like they are chocking, dying, having a heart attack, going crazy, or losing control.  They often end up in emergency departments and are frequently hospitalized but no diagnoses are made.  Without proper treatment, they become homebound, afraid to go anywhere or do anything for fear that whatever they do may precipitate another Panic Attack.

The treatment of the Anxiety and Panic must begin with recognition.  Undiagnosed, these conditions ruin life’s quality and diminish performance.  Early diagnosis, which leads to early intervention, is the fastest road to wellbeing.  Too many Anxiety victims remain undiagnosed, however, because they visit sub-specialists – doctors who are trained to look for diseases within their own subspecialties rather than examine the whole patient and try to understand the entire clinical picture.  It is better to start with a specialized generalist – such as a Family Medicine or an Internal Medicine specialist – and let these specialists refer the patient to a sub-specialist if there is need.  The fragmentation of modern medicine into myriad tunnel-visioned subspecialties has relegated a secondary role to the primary care specialist and, because of that, too many patients continue to suffer needlessly.

2008 - ISSUE 74