Cross country skiers move across the Yellowstone backcountry. We know that venturing into the outdoors is good for us and our mental health. Sometimes, however, even the solace of open spaces isn't enough. Mountain towns in the West have as many people experiencing loneliness, isolation and anxiety as anywhere else. Photo courtesy Neal Herbert/NPS
I was asked by a faithful Mountain Journal reader to identify the top five reasons why individuals seek professional help behind The Blue Door.
I’m not a distill-things-into-hard-categories kind of guy or therapist. But I got the gist of her inquiry. The question was on my mind when I went out to breakfast at a local eatery in Bozeman. I approached the cafe in my sedan and was a bit annoyed by the speed at which a truck was following closely behind.
I sloughed off the concern I felt to my intolerance of motorist bad manners and parked my car only to have the driver of the truck pull in next to me. Huh, okay I muttered to myself as I strolled toward the rear entrance to the restaurant.
The gent in the truck had hustled around the building and was now in front of me in line. Okay, now what? Once I placed my order the only single seat open was at the window counter next to, yep, him. Noting this, I opened up our daily newspaper and enjoyed a late Friday morning repast of cappuccino, baked eggs, and solitude. My counter mate finished a phone call where I overheard words like “deal” and a name like “Daines.” Not overthinking it, I continued reading the front page story about fires in our wildlands and firings in The White House.
And then an unexpected encounter happened as they often do.
This handsome, muscular, early-forties, extroverted man who had tailgated me in his pickup turned and said, “I just got off the plane from Austin and am I ever glad to be back in Montana.”
It isn’t necessarily how I thought our first words might go.
We exchanged pleasantries describing our gratitude for our sweet Montana home, the growth-related pressure of folks moving to our town and to his town, Helena—how growth is a mixed blessing.
He then confessed that he suffers from anxiety especially on airplanes where he is prone to panic attacks.
Yes, ranking number one on the top five list of why clients seek me out is anxiety. Some 40 million Americans, according to comprehensive surveys, are thought to experience some sort of anxiety disorder.
My private practice sports a Blue Door (which I’ve mentioned before) and a steel plate threshold. The intention behind the door’s color and the tensile strength of steel is that I want individuals who visit me to be aware that they are passing over a threshold.
"Anxiety is the fuzzy charged sensation. It accompanies the thought that I am in some way unsafe. Physically, it is the sensation that is triggered, in part, by shallow breathing and akin to holding one’s breath. Sometimes, in fact, people might hold their breath when becoming anxious and feel as if they are about to pass out."
Another meaning of threshold is: “the magnitude or intensity that must be exceeded for a certain reaction or phenomenon to be manifested.” What does it take or feel like to pass the threshold of one’s capacity to healthfully manage anxiety?
Anxiety is the fuzzy charged sensation. It accompanies the thought that I am in some way unsafe. Physically, it is the sensation that is triggered, in part, by shallow breathing and akin to holding one’s breath. Sometimes, in fact, people might hold their breath when becoming anxious and feel as if they are about to pass out.
In accepted clinical terms anxiety is the energetic force behind all obsessions and compulsions including perfectionism, compulsive exercise, and eating disorders. It is also the force that degenerates into depressive tendencies. When drained by the toll anxiety takes on our psyche, we can sink into a depressive trough.
Experiencing a little bit of anxiety is normal, as in what both youngster and parents together experience the first morning that a kindergartner is sent off to school or venturing into territory that is beyond the familiar. But more intense forms of anxiety, while common, can lead to conditions that may not be.
Image courtesy Creative Commons
Depressive moods are the second most frequent symptoms I see in my practice and certain data suggests that over 216 million folk (a figure cited in 2015) suffer from its power. Sometimes it’s reference more colloquially as experiencing the blues.
I use the term depressive rather than depression since energetically it is an adjective not a noun. For an individual, it actually takes considerable effort to be depressed and dwell in it even though we tend to consider depression as a lack of energy. As with anxiety there can be differing degrees of depression.
Many conventional SSRI uptake inhibitors (drugs) tackle both anxiety and depression. It sounds more accurate to my ear to say I am depressing than “I am depressed;” although the latter is how it is often expressed.
It’s like if we are driving a vehicle (self) and unsure of the terrain or traffic (anxiety) we ride the brake, depressing motion. In clinical terms something like “unipolar depression/mood disorder” might be one of the categories.
(I should also note that while loneliness is not itself a condition, feeling profound loneliness can be a byproduct of anxiety and depression. All of us yearn for human connection. Loneliness is considered a growing phenomenon, so much so that the Aspen Ideas Festival (see video at the bottom of column) recently devoted an entire seminar session to exploring its causes and impacts).
So what happens if depression is actually an expression of being bipolar—the third most frequent reason people come to my practice?
Two recent films screened by the Bozeman Film Society, Andy Irons: Kissed by God, andInfinitely Polar Bear, drew our communities attention to this often underdiagnosed or misdiagnosed condition.
Jessie Close, a local author and sister to both actress Glenn Close and wildlife artist Tina Close wrote about her challenge with Bipolar disorder in her book Resilience: Two Sisters and a Story of Mental Illness.
I praise Jessie’s courage, and the support she has received from her sisters and brothers, in pushing to destigmatize bi-polarity.
Resilience, the memoir by Gallatin Valley author Jessie Close is a powerful read.
Jessie was also a resource for the post Infinitely Polar Bear film discussion, is an outspoken advocate for those among us suffering from mental illness and along with her sister, Glenn supports a foundation; Bring Change to Mind, founded in 2010.
The genetic and biochemical factors that influence or determine the effect of bipolarity, chronic depression, and schizophrenia are forces beyond the scope of this column. Yet in a counseling practice an assessment must be made as to the source of the disturbance being suffered.
The accurate assessment of a person’s condition in large part determines outcomes. If I miss the underlying psychological complex then no matter how sincere the exchange between us is, the driving problem will still be unaddressed, influencing us from the shadows. Correctly diagnosing a condition can take time.
My deepest sorrow is to have either misdiagnosed or underestimate a person's condition. For instance, if a client is suffering from bipolarity we can work together to manage this lightning hot condition, as long as it is type II. If we mistake one’s bipolarity as type II, when it is actually type I, then medication will not necessarily be an aspect of treatment. And unmedicated bipolar I is a crisis waiting to happen again.
This can lead to life-threatening choices. What is the difference? Simply put, bipolar I is what the above mentioned movies addressed. The role that genetic predisposition plays in both forms is significant and it is helpful to remember that both the manic episodes and the depressed episodes are both expressions of depression.
Here I should note: getting a correct diagnosis and arriving on a treatment regimen can be liberating for the individual who—were they existing in a more Draconian age—might otherwise be dismissed as “crazy.” There are many people, from those involved in business, the arts and community endeavors who returned to being notable, high-functioning contributors to society after getting treatment.
You know many of them. They make the news, entertain and inspire you, teach you, help you, and live next to you. They receive treatment and you don’t know it.
Another genetic predisposition, greatly exacerbated by social media and cell phones, is Attention Deficit Disorder. Adult ADD has made a sprint into fourth place on my list and the number of clients trying to deal with it has grown markedly even over the last 10 years. This is not reflective of a personal bias I may or may not have against technology and gadgets and their potential for becoming crutches so that people can avoid human contact.
"Getting a correct diagnosis and arriving on a treatment regimen can be liberating for the individual who—were they existing in a more Draconian age—might otherwise be dismissed as “crazy.” There are many people, from those involved in business, the arts and community endeavors who returned to being notable, high-functioning contributors to society after getting treatment."
Ever since watching a PBS special, ADD and Loving It was aired in 2009, the way ADD presents became much more obvious for me. ADD and anxiety can be confused, as can lack of impulse control. “I can only do one thing at a time,” is one thing I hear. Or it might be a sharp disproportionate response to a human encounter that offers a hint of this condition.
The behavior of “being all over the map” or the appearance of incomplete projects littering the work or domestic scene are also common symptoms. What can be confusing is that the attention span, allowing for certain kinds of multi-tasking that enhances social media skills is the same force as ADD: This, and then that, and this other thing and that...we live in a brave new ADD world.
If we looked at the number of insurance claims submitted by diagnostic category, Adjustment Disorder would place first. But it’s number five on my list. The symptomatology of this “disorder” states: “The development of emotional or behavioral symptoms in response to an identifiable stressor(s) occurring within three months of the onset of the stressor(s).”
I apply this diagnostic category to a pervasive cluster of trouble expressed primarily by anger/rage (men) and fury (women) exacerbated by the underlying disease of our times, chronic sleep disturbance. We live in an over stimulated world set in national/global uncertainty regarding policy toward global tension and environmental degradation. We’re told that getting enough sleep matters. Let me tell you from the perspective of a clinical professional, it’s true!
I would imagine that many readers here have lost sleep over various developments happening in the political-environmental-social state of the world?
What could possibly be stressing us? Stress is but the initial expression of discomfort that individually and socially we passed through years ago. We now live in a chronic state of distress fueled by inadequate sleep: we need eight hours of nightly sleep.
This distressed state is not static but vacillates between lesser aggravation, which is the stressed state, and heightened vigilance, a dysregulated state; episodes of emotional explosiveness or conversely, sodden despair that nothing matters.
The nature of our mind, as it habituates to stress as it’s norm, is that we assume when not experiencing distress that we are “normal.” This can be wickedly misleading if we are merely becoming acclimated to accepting more and deeper forms of stress without realizing it. That’s how people get into trouble.
"As in any labyrinth worth its salt, there is a way through it. The communities where we live are filled with individuals who have made the passage. To do so should be considered a journey of praiseworthy courage rather than viewed derisively as a sign of weakness."
What is a definition for normal we might all agree upon? Is it to know what it is to be relaxed, self-assured, calm, clear, settled, at peace?
This means that the jolt we feel when disturbed is one that comes from that awful startle reaction to literally missing a step on a staircase. The emotional staircase is built like this: 1. Grounded, 2. Stressed, 3. Distressed, 4. Dysregulated. Once we are dysregulated, when symptoms are both manifesting in our body and mind with little or no reserve from which to draw, the strategic descent back to grounded is precipitous. Imagine negotiating an unstable sloped scree field.
As in any labyrinth worth its salt, there is a way through it. The communities where we live are filled with individuals who have made the passage. To do so should be considered a journey of praiseworthy courage rather than viewed derisively as a sign of weakness.
Although “talk” therapy is dismissed by many, it is still a solid starting point particularly if the conversation is depth oriented and not just “feel good” symptom management.
Depth here means the willingness on the behalf of both client and therapist to risk taking the adventure into the forbidden, forgotten, shadowlands protected by a reactive ego. None of this, the troubles we have within ourselves, happens in isolation. Yet we maintain this crooked thought that “there is something the matter with me.”
This is oddly true if one believes that she or he is separate from the whole teeming story of human existence buzzing in and around us.
Circling back to number one on my list, anxiety is the effect on our psyche of the belief that we are “somebody” separate from this wild, chaotic, mysterious, infinite process of creation: unyielding, untamed, and impersonal. It can be amazing how when you let the rest of the world in, and open yourself up to being part of it, imperfection and all, how stress and anxiety can be set free.
EDITOR'S NOTE: Neither Mountain Journal nor Timothy Tate are dispensing or recommending mention health treatment options. If you are feeling any of the symptoms mentioned in Tate's column, contact your local mental health hotline for a referral. See Aspen Institute panel discussion on loneliness below.
About Timothy Tate
Community Psyche columnist Timothy J. Tate, who lives in Bozeman, Montana, has been a practicing professional psychotherapist for more than 30 years. For decades, he had an office on Main Street behind The Blue Door. He still works with clients downtown.
