Anxiety disorders take many forms, from social anxiety to phobias to obsessive compulsive disorder, and our understanding of them grows daily. However, modern concepts of anxiety and how we treat it also have some baggage: old-fashioned (and in some cases, ancient) beliefs about anxiety disorders continue to influence how we talk about it today. While some historical myths about anxiety are now well-known to be myths — we're all pretty clear, for instance, that women don't suffer 'hysteria' because their wombs wander around their bodies, an idea that was part of medical thinking until relatively recently — others still have sway over our conversations. And it's important to sort out why they're wrong.
Some of these myths are relatively straightforward in their inaccuracy, but others need a bit of unpacking to see why they're still around and how they continue to shape the way we think about anxiety. Data from the Anxiety & Depression Association of America shows that anxiety disorders are likely the most common mental health issue in America, affecting approximately 40 million adults, so little misconceptions can have a big impact. Next time you hear one of these tidbits in conversation, challenge them straight up, because nobody has time for that.
1. That Anxiety Is Always Linked To Depression
This is one of the oldest beliefs about anxiety there is, and it's still influential today. People who have anxiety disorders will often face questions about their moods in other ways, as common perception commonly links depression and anxiety together. As a belief, it can be traced back to the work of British writer Robert Burton, who in his famous 1621 book The Anatomy Of Melancholy discussed symptoms of anxiety, from panic attacks to phobias, with unerring accuracy — but claimed they were all part and parcel of "melancholy", or depression. He believed that depression was characterized by both fear and sorrow, and that all anxiety and panic was melancholic in origin.
Burton's work would be influential for hundreds of years. Even as definitions of anxiety and depression moved and changed, they were commonly seen as interrelated; in the 1950s and 60s in the U.S., many patients with depressive symptoms were often diagnosed as "anxious", until the 1970s made depression a more common separate category of diagnosis. It's possible and common, however, for people to be anxious without any symptoms of depression (and vice versa), so don't make any assumptions about their comorbidity.
2. That Anxiety Is Just An "Attack Of The Vapors"
This may sound like it's decidedly antiquated, but the notion of "attacks of the vapors" are more persistent than you might think. The origin of the idea of the vapors — that anxiety, an overriding terror or "panophobia", emerges from vapors in the body — comes from early modern medicine, and was hugely common, according to one study, from the 16th to the 18th centuries. People who had panic attacks were said to be having affection vaporeuse, something often remedied with smelling salts composed of ammonia (which is out of favor these days, as it's been shown to be pretty low in efficiency).
Attacks of the vapors were seen as merely emotional in origin, and were dismissed as brought on by too much 'agitation'. In other words, they were the product of working yourself up. Every person with anxiety will likely recognize this thinking: "just calm yourself down! You're getting over-emotional about this!" And it needs to stop.
3. That A Paper Bag Will Help You During A Panic Attack
It's not clear where this belief came from; it's been omnipresent in American cultural depictions of panic attacks since at least the mid-20th century. However, it's now known to be less of a cure-all than first thought. The original thinking behind giving a hyperventilating person a paper bag was that breathing the exhaled air in the bag, which is high in carbon dioxide, would increase CO2 levels in the blood. While this does work, it's now known to be far slower than initially believed, and can be extremely dangerous for people who aren't in fact suffering from hyperventilation and encounter serious health issues from the CO2 spike. It also contributes to a one-dimensional portrayal of people with anxiety — panic attacks can occur in many different forms, and are most effectively managed through mindfulness techniques like situational awareness and focus. (Not through blowing into a paper bag.)
4. That It's A Weakness Of The Nerves
People with anxiety still face a lot of cultural criticism of their supposed "weakness," and that's a belief that's got very old origins. Anxiety, in the 19th century, was placed under the heading of a condition called "neurasthenia," a weakness of the nerves brought on by over-exertion and the strains of modern life, and was commonly thought to be an affliction produced in those who lived too excessively or weren't up to the pace of contemporary existence. The Atlantic, in a feature on neurasthenia, explains that 'neurasthenics' were often people who were in some way defying gender expectations: men who couldn't earn enough to support their families and women who spent too much time away from their homes were seen as particularly vulnerable. This kind of thinking contributes to shaming of people with anxiety and is distinctly unhelpful.
5. That It's Caused By An "Irritable Heart"
We now know that heart palpitations are a symptom of anxiety, and that there's a connection between anxiety and the possibility of cardiovascular issues. However, it's still relatively common to hear people referring to anxiety as basically a heart condition; one woman in her 70s of my acquaintance refers to her flying phobia as "the flutters." That's not true, and it's a way of thinking that dates back to the Civil War, when doctors encountering shellshocked soldiers with PTSD coined terms like "irritable heart syndrome" and "soldier's heart" for their symptoms of panic and anxiety. People with anxiety issues do not have innately problematic hearts. That is not a thing.
6. That The Best Cure For Anxiety Is A Quiet Life
The idea that anxiety could be treated by protecting yourself from the things that cause misery and panic is an extremely old-fashioned (and unhelpful) way of thinking. Sir Richard Blackmore wrote of melancholia and anxiety in 1725, "If Inquietude Be The Distemper, Quiet must be the Cure" — and everybody from the ancient Greeks onwards recommended people prone to panic and anxiety disorders should lead retiring existences. That's still common advice, but we now know it's wrong. Leading a "quiet life" can be an excuse for practicing avoidance — and a safe bit of exposure is one of the main ways to treat phobias and PTSD. People with anxiety disorders are perfectly capable of leading healthy, normal lives with treatment that don't involve them escaping to a desert island away from stressors.
7. That Healthy Living Will Make Anxiety Disappear
"Eat well!" "Exercise!" "Get a lot of sleep!" Every person with anxiety has encountered a large quantity of well-meaning advice about how leading a healthy life will make their symptoms go away. It's a tradition that's got many centuries of thinking behind it; Robert Burton himself emphasized that melancholics with anxious tendencies should eat good food (he favored good-quality bread, lean meat and fruit), take natural herbs and go for lots of walks to have the best chance of beating their problems. While this is fine advice, it does nothing to address underlying causes of panic and anxiety disorders, and people who have them may feel shame or distress when they need therapy, medication, or some combination of the two to feel well.
Whether you've internalized these anxiety myths yourself or are noticing them in others, it's time to root them out of the conversation. Our understanding of anxiety gets more sophisticated daily, and old-fashioned views and judgements do more harm than good.