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Hello old friend! Generalised anxiety disorder is sort of exactly what it sounds like – a free-floating but excessive level of worry which can’t be shrugged off. Nearly six people out of 100 are thought to suffer from generalised anxiety disorder in this country,[33] and DSM-5 (the fifth edition of the most popular diagnostic system for mental disorders in the US) says the period of time a person suffers for before diagnosis is important – it puts it at at least six months, to highlight the difference between those with worries based on something specific in life, and those for whom worries will not pass no matter what happens. This kind of anxiety means you worry even when there’s nothing actually wrong, or in a way that’s disproportionate to any actual risk. When you get on top of one worry, another will pop up – and your mind always races to the worst possible scenario in each case.

These worries will nearly always have a physical effect too. You may ‘feel’ a sense of doom, have headaches, suffer from insomnia or feel tired or rundown all the time. Other fun results of GAD that I’ve experienced include a terrible short-term memory; difficulty concentrating on anything; and a massive sense of irritation, directed at myself and others. There are countless other symptoms, which I still sometimes look up on dubious medical sites as a special treat (I’m kidding: I do it to tick off any weird pains I have). The disorder affects women more than men, and it’s a contributing factor in some cases of depression too, hastening the need for treatment.

Much is written about stress in the modern world. The Office for National Statistics says an estimated 137.3 million working days were lost due to sickness or injury in the UK in 2016, and that a third of those days were lost to mental-health issues.[34] We’re constantly told that our lives are full of worry – about money, work, family and relationships. These very real issues can make the most relaxed person feel anxious. GAD means you might worry frantically about these issues – as well as a whole host of other ones which seem to tack on to the initial one. I can easily spend hours worrying about money, which seems like a rational focus, but my mind will immediately take me to a place where I’m stranded, bankrupt and chased by debtors. On top of that, I’ll suddenly feel besieged by anxiety about illness, about whether I might have offended someone at work, about whether I remembered to blow out a forgotten candle, or maybe I’ll start thinking I’m getting a serious illness. One worry ushers in another, and another, until your mind is swarming with them and you feel almost despairing. It’s a tangled web that happens in warp speed – you don’t know where to begin trying to tackle the mess.

David suffers with GAD, having lived with anxiety for as long as he can remember. ‘When it’s at its worst, it manifests itself in both physical and emotional ways. Physically, I always feel tense, have sweaty palms, am quite restless and unable to concentrate for long periods. If something is on my mind I get full-blown stomach aches, palpitations, sweating. Mentally and emotionally it manifests itself in constant worrying, racing thoughts – the inability to rationalise things or live with uncertainty. For instance, if I am unsure of how a meeting at work might go, I will obsess about it all day, and be unable to focus on anything else until it is resolved. I have phobias of certain things – flying, food poisoning/general health problems. It’s exhausting all round, really.’

Exhausting, because your whole body is trying to expend excess adrenaline. The adrenaline that comes with GAD is extraordinary. My default position is lying down in bed, snoozing away. But at my most anxious, I have the energy of a young gazelle. I could do star jumps for hours if I wasn’t so busy feeling like shit and biting off the skin around my nails while I tap my feet and fail to concentrate on anything for more than thirty seconds. It comes in like a violent wave to the shore, knocking over anything in its wake, and shocking you with its force. You wake up to it rushing into your belly, pushing up into your throat, telling you that danger is near. Adrenaline – great in a real crisis, terrible when there’s nothing to worry about. It feels way too real to be ignored, so you don’t. Something must be wrong. In a real crisis, adrenaline (and its ugly sisters norepinephrine and cortisol) might help you pull a child from a burning building with Herculean effort. With anxiety, you just feel physically ill – a sweaty, shaky, nauseous bundle of nerves. This contributes to a feedback loop – you feel physically full of fear; and this adrenaline might cause a panic attack. After that has subsided, you look for reasons as to why it happened – leading to ruminations and obsessive thoughts searching for a legitimate cause. You spend a lot of time fearing another episode of panic and that leads to extra adrenaline … and on and on.

The other symptom of GAD that I always find overpowering is the feeling of impending DOOM it can bring. I remember visiting a local supermarket with my mother several years ago, when I suddenly felt as though the world was about to end. The colours in the shop felt all wrong, and everyone around me looked sinister and unfriendly. I could feel my emotions plummeting, as though a dementor from Harry Potter had sucked all of the joy out of my body. From nowhere, I felt utter dread, as all the while people were just buying their dinner. The doom sensation is incredibly scary – you feel like there must be a reason for it – just as with adrenaline rushes, it’s hard to shake it off and chalk it up to anxiety when every part of you is telling you that danger is approaching.

This feeling of doom is not unique to me or my fellow sufferers in the twenty-first century. In 1773, London physician George Cheyne wrote The English Malady, a book in which he addressed his own anxiety, describing his ‘fright, dread and terror’.[35] He might not have experienced it in his local Sainsbury’s, but the feelings are the same.

I’ve described some of the anxiety illnesses most commonly seen. But maybe you don’t get the doom, or the panic attacks, or the weird eye-twitching. That doesn’t mean you don’t have anxiety, or that your experience is abnormal. I could write a book on all the various symptoms alone, or a PhD which would entirely consist of the mad thoughts and neuroses that I’ve had in my life. Nobody would read it though, probably not even me. I say this to reassure you that even if none of this sounds like you, it doesn’t mean that your anxiety is less awful or somehow not as life-affecting as anybody else’s. Mental health is not a Top Trumps game (this probably dates me horribly), and if anxiety has given me anything positive, it’s taught me to be more empathetic with others who struggle in life. We all have bad brain stuff. Don’t minimise your stuff, or compare it with other people’s. Having a loving family or a good job doesn’t mean you have to stay quiet when you’re struggling with mental-health problems – however small you think they are. You know better than anyone else whether something in your brain feels wrong – and if it does, seek help. Anxiety disorders usually get worse without intervention – whatever that ends up meaning for you. The things that have worked for me have been therapy, drugs and running. Your version of help might be different, but do make a serious effort to seek it out. It’ll be the best thing you can ever do for yourself, and for those who love you.

Anxiety is nothing new. Ancient Latin and Greek literature repeatedly references fear and worry. In the seventeenth century, the Oxford scholar Robert Burton described anxiety in his book The Anatomy of Melancholy, in which he wrote ‘what cannot be cured, must be endured’[36] – a pretty good saying even now. Panic attacks were referred to as ‘panophobias’ in the eighteenth century, and we’ve all heard the phrase ‘attacks of the vapours’. In 1869, American doctor George Miller Beard described neurasthenia – meaning nervous weakness – as a condition that the middle class was increasingly suffering from.[37] He believed that they were overcome by the rapid advance of modern society. Come talk to me about rapid advance now, Beard: just try to use a parking meter without a phone, a credit card or a degree in maths.

Sigmund Freud wrote that ‘anxiety [is] a riddle whose solution would be bound to throw a flood of light on our whole mental existence.’[38] He spent a lot of time thinking about this particular mental-health problem, and initially thought that anxiety had something to do with the trauma of being born. Later he suggested it was probably also about the death instinct or some form of aggression operating within ourselves. Above all, he thought it was connected to the helplessness of infants – who can’t survive without the assistance of other people, creating a trauma that sticks with us. Then again, Freud came up with the Oedipal theory, so I’m shocked, that like Philip Larkin, he didn’t chalk anxiety up to your mum and dad fucking you up.

But despite this wealth of material, anxiety as a stand-alone mental illness was not recognised properly until the 1980 publication of DSM-3, which had a chapter on anxiety disorders.[39] These included phobic disorders, social phobia, panic disorder, GAD, obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD). Wahooo! We were recognised! It’s nice to finally get some recognition … I’d like to thank my family, my friends and my dog.

This stand-alone diagnosis is important – no longer would anxiety be lumped in with other mental-health issues (though of course, many overlap). And that coincided with the introduction of treatments that might actually work. Thank God we now live in an age where medicine is not only effective but also has the added benefit of not being utterly punishing. Not for us the hideous ‘have a bash’ treatments that the mentally ill suffered through the ages – trepanning (having a hole drilled into your head to reduce pressure), lobotomy (which involved severing neural connections in the brain so as to relieve certain severe mental conditions), diathermia (using a current on the brain to jolt patients with psychosis), or being submerged in freezing water to treat women with hysteria. Hysterical women crop up a lot in history – from Hippocrates, who thought women’s wombs wandered (what a band name), to English doctor Thomas Sydenham, who wrote that hysteria was a malady which nearly all women suffered from – ‘there is rarely one who is wholly free from it.’[40] The Victorians were mad for trying to give women orgasms – whether or not they wanted them – to stop women being unhappy or angry, or maybe just not the perfect subservient wives that men expected. Between 1864 and 1889, entries at one asylum in Virginia recorded the reasons that patients were said to have become unwell. These included: laziness, egotism, disappointed love, ‘female disease’, imaginary female trouble, jealousy, religion, asthma, masturbation and ‘bad habits’.[41] Worryingly vague, and although not given as the main reason for admission, they seem hard to disprove …

As an aside, if you want to read more about how women with mental-health problems have been treated over the years, read Mad, Bad and Sad by Lisa Appignanesi.[42] It’s fascinating on the subject of how women are still much more often categorised as mentally unwell or ‘unbalanced’ than men.

The most effective treatment for anxiety is usually agreed to be talking therapy, which many credit Freud with bringing to the fore. His famous description of Josef Breuer’s treatment of the patient Anna O. (later revealed to be Austrian Bertha Pappenheim, the founder of the League of Jewish Women) is widely regarded as the beginning of psychoanalysis. Guess what she was diagnosed with? Yup, hysteria.

Cognitive behavioural therapy (CBT) is now seen as one of the most effective types of treatment for anxiety disorders – and the one recommended by the NHS.[43] Developed in the 1960s by Aaron Beck, it’s a form of therapy which involves re-examining your thought patterns and challenging negative behaviour. CBT is also recommended in the treatment of depression, schizophrenia and bipolar disorder and there is evidence it can help with chronic fatigue, anger issues and sleep problems. Having had therapists in the past who were very keen to start right back in my early childhood and work through my entire life in a bid to find the one key thing that made me anxious, I was relieved to try CBT and cut out much of this process. The first thing I was given was homework – a sheet of paper with boxes on it. In these, I had to write down my big irrational thoughts and what I thought would happen if the worst came true. Sometimes the sheets would look like this:

Huge worry: What if I start hearing voices and believe aliens are trying to abduct me?

Likelihood: HIGH.

Conclusion: I’ll have to live in an asylum and I’ll never see my family again.

The homework then required me to write down the worry again, and then to consider a more realistic conclusion:

Huge worry: What if I start hearing voices and believe aliens are trying to abduct me?

Likelihood: Actually pretty low – in 2014, an estimated 0.7 per cent of the UK population were reported to show symptoms of psychosis disorder. [44]

Conclusion: While there is a slim chance that I might have a psychotic illness, there are many people who live full lives while coping with serious mental-health problems, and very few people end up in what I think of as ‘asylums’ anymore. There would be a plan of action and I would have great support in place.

I was sceptical of such a method – I’d been dealing with catastrophic worries for years; it felt too simplistic to merely write down my worries and try and reframe them. But what do you know? It started to work. I’d write these alternative conclusions and quickly forget them. Later on, when inevitably another new and SCARIER worry cropped up, I’d do my normal freak-out and start falling down the rabbit hole of catastrophe. But then something would stop me – I’d remember the worksheet and ask myself if I could see a different outcome, whether maybe I had a choice in how far I chose to take the thought. I still do this in my head from time to time – when I feel my thoughts racing and have to rein them in.

CBT has worked for me, and for many others who have been lucky enough to receive this treatment. But current NHS waiting list times often mean that medication is offered first.[45] In the course of writing this book, so many people I spoke to were still on the waiting list to have a limited number of CBT sessions, and would take medication as they waited for talking therapy. The medication most commonly prescribed for anxiety disorders is selective serotonin reuptake inhibitors (SSRIs), which are thought to increase the levels of the chemical serotonin in your brain. After carrying a message between nerve cells in the brain, serotonin is usually reabsorbed by the cells. SSRIs work by blocking this absorption, meaning more serotonin is available to pass further messages between nearby nerve cells. You might also be offered serotonin–noradrenaline reuptake inhibitors (SNRIs), which increase both chemicals, or benzodiazepines, which have a sedative effect and can’t be used for a long period of time because they’re addictive. Speaking personally, they’re bloody amazing for a short window where you’re finding it hard to get through the day. But be aware that the doctor will probably not give you more than two weeks’ worth, for good reason. Especially if you go in wild-eyed, praising them and loudly insisting you must have more. Not my subtlest move.

Whatever meds you’re prescribed, you’ll start on a low dose, and be monitored by your GP to see whether you need a higher dose, and to check your side effects. Don’t expect relief immediately; usually these drugs don’t become fully effective for 2–4 weeks, which I know can feel interminable, but don’t stop taking them, or give up hope.

As with so much to do with mental illness, taking drugs for mental-health problems still comes with a huge stigma attached. This is in part because some who have not had cause to take them find it hard to understand why other people do. It’s also to do with ignorance, or a lack of education around what the meds actually do. Headlines in some sections of the media don’t help, to put it mildly. A NATION HOOKED ON HAPPY PILLS yelled the Daily Mail at the end of 2017[46] – the implication being that those of us who take antidepressants do so for an easy fix, or for a high that doesn’t actually exist.

So, for clarity: does taking antidepressants mean that you’re crazy? (No.) Do they mean you’re dangerous? (No.) Don’t they make you a robot unable to feel emotions? (Hahaha. NO.) But yet still we feel shame or hesitancy in telling those we love about them. A 2011 study showed that one in three women in the UK will take antidepressants in their lifetime, and yet 18 per cent won’t tell their families and one in ten won’t tell their partner.[47] I hesitated to tell my partner that I took medication, worried he’d think less of me. Ridiculous, really. And he didn’t. At all.

I shouldn’t need to argue why it’s so important not to judge someone for taking medication when they’re struggling. I’d love it if we lived in a world where taking SSRIs was just like taking paracetamol for a headache. But we’re not there yet. I’ve been taking them on and off for years now, but I didn’t tell anyone about them for fear of looking like I was abnormal. I didn’t know anyone that took them and I didn’t want to be any different. Except I did. I knew tons. When I finally told people (gradually, cautiously) so many of my friends and family said that they’d had cause to use them at some point in their lives too. Some for a few months, some for a few years. Some were adamant they’d never come off them. A few people were surprised I was being open about it, and urged me not to disclose it to employers, showing that the stigma is real.

I’ve not come to any fixed conclusion about how long I’ll continue to take them. But I do know that, personally, they dug me out of the pits of despair and took me back to a place where I could think about something other than death and destruction. They didn’t flatten my emotions, rather, they let me feel something other than utter misery. They gave me the chance to start figuring out what would help me be actually happy. Because I’m sorry to disappoint but they don’t make you happy – no matter what fear-mongering headline might scream about mind-altering drugs. They just give you a chance to not be so fucking sad. And they don’t work for everyone, and they can come with some pretty serious side effects. I get night sweats (gross and fun to explain to a new partner), and you might feel nausea; or dizziness; or lose interest in sex, but not always, and you have to decide for yourself how much you can put up with. Either way, don’t be scared off medication by people who freely judge because they’ve never experienced the sadness and worry that others have. Lucky them, but you do you.

If you need further reassurance, a 2018 study (published in the Lancet) which looked at the efficacy of twenty-one antidepressants found that all the drugs tested were more effective than a placebo in adults with major depressive disorder[48] – though sadly the data can’t show which drug would be most likely to work best for any individual. The six-year study was hailed by many experts, who heralded the results as a blow to the lingering stigma that still surrounds medication for anxiety and depression.

For all the talking therapy and medication I was lucky enough to be given, however, I was never able to completely get myself on an even keel. The drugs took me out of doom, the talking reassured me that I could keep my thoughts in check better, but I always felt like both were only getting me so far. It was as if I was always tentatively standing on the top of a hill, while everyone skied past me and beckoned me down (I’ve never skied, it looks completely terrifying). And that’s fine – nothing is a miracle cure and you can’t expect total relief from one remedy. I’m glad I was able to get help from both, and I’m still grateful that they got me to a stage where I could find more things that helped. Things that might help me get to be really happy and not in a place where I was just ‘managing’.

It’s not that managing is a terrible place to be, but it can be stultifying. When you get there, it feels amazing – as though you’ve jumped a massive hurdle. But then you find that there are other hurdles in the distance, and it’s frustrating when you want to tackle them too. That’s another little annoyance that mental-health problems are likely to throw up – however far you’ve got with your recovery or management, there are always other levels to tackle, new fears to confront. The journey is never completely over – no final, happy end to the worries you’ll face. It’s a long and sometimes slow process, but once you’re on board, you realise how much better it is to be taking it than the alternative. That doesn’t mean that you won’t get disheartened, but remember how far you’ve come already. And at the risk of sounding like a motivational coach, your progress is your own. When I realised I could go on the Tube without fainting for the first time in sixteen years, I was prouder than a stage-school parent at a recital. The feeling was indescribable, and I carry that memory with me when I feel like I’m not as brave or as competent as those around me. Small steps.