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Dear Dr. Gordon,
I have been having trouble with anxiety for a long, long time. My doctor has tried a number of different medications, and I have been in therapy, too. I still have a lot of anxiety – nothing seems to really help. At the same time, there is a lot in my life to be anxious about – I have three kids, and never enough time or money to do everything I need to do! Also, some pretty bad things happened to me when I was little, and these bother me a lot. Do you have any advice for me?

— Anxious in Framingham


Dear Anxious in Framingham:

You sound to me like someone who has been working on this problem for a while, and you seem to know yourself quite well. You also seem to appreciate that anxiety can be caused by a lot of different things, or from a combination of different things. Since I don’t know you personally, please take the advice I am about to give you as general advice which may or may not be applicable and useful to you.

When I see a person who is suffering from anxiety, I usually try to understand what they are going through from four different perspectives. When I put these four perspectives together, then I often feel that I have a good chance to understand the person as a whole, real person. These four perspectives are:

1. A social, here-and-now perspective. Is there something going on the person’s life right now that may be making them anxious? This could be an abusive relationship, a terrible financial problem, or something like racial discrimination or any other current problem that the person is having trouble dealing with. For this sort of issue, counseling and coaching are best.

2. A biological perspective. Sometimes anxiety can be caused by a sort of "chemical imbalance." When this is true, usually we find that other members of the person’s family have had problems with anxiety, or depression or sometimes alcohol or other substances. For this sort of anxiety, medications are often helpful and the ones that seem to work the best are actually medications that are often called "antidepressants" – medications like Prozac, Paxil, Celexa and so on.

3. A psychological perspective. Practically everybody (OK, everybody) has baggage and scars from their past, and sometimes this baggage from the past is being experienced in the present as anxiety. For this sort of issue, counseling to deal with the past really works best.

4. A spiritual perspective. Sometimes something has happened to a person that just seems to take the meaning out of living. For example, maybe something terribly unfair happened to an innocent child (like cancer) and this shakes the person’s faith or belief system in a serious way. At times these crises of meaning can cause anxiety. In a case like that, being aware of what the problem is, and getting appropriate counseling – maybe from a pastoral counselor – would be the best idea.

Of course not all of these perspectives apply to any one person. However, when I see a person who is suffering from anxiety, and it’s not getting better, then I usually wonder if maybe something is going on in one of the other perspectives. For example, it is usually a mistake to try to treat problems that are primarily psychological with medications, and it is equally a mistake to treat problems that are primarily biological with counseling alone.

Maybe it would be a good idea for you and your counselor and your doctor to go over these perspectives to be sure that your plan for recovery is everything it could be. I hope this helps!!

Chris Gordon

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