“The chief problem about death, incidentally, is the fear that there may be no afterlife — a depressing thought, particularly for those who have bothered to shave. Also, there is the fear that there is an afterlife but no one will know where it’s being held.” – Woody Allen

Poor Woody Allen. Always the anxious existentialist. Almost every character Woody Allen ever played portrayed a portrait of generalized anxiety disorder run rampant. The quote above, while humorous, actually describes deeply held fears based on the most common underlying theme of generalized anxiety: fear of death. And what comes, or doesn’t come, afterward.

Remember that anxiety exists on all levels: the mind, the body (brain), and the spirit. One of the ways we work with the anxious mind in a clinical practice is to explore belief systems on the conscious and unconscious level.  We bring what is unconscious into the light of day so we can hold it, examine it, turn it over and see its many facets. It can be surprising how often these unconscious beliefs are running like programs in the background on our smart phone; sucking up our energy and directing our thoughts.

So many times the root of anxious thinking can be found in conscious and unconscious, yet deeply held, religious and spiritual beliefs. Having firmly held spiritual beliefs that provide comfort, not fear, makes it easier to let go of anxiety and easier to face the fact that none of us will get out of here alive no matter what we do. No matter how well prepared we are, no matter how healthy our diet and exercise regimen, we all have our appointment with death. We just don’t know when it is.  Having comforting spiritual beliefs is a protective factor when it comes to facing this fact and it is a protective factor in generalized anxiety.

Focus on the word ‘comforting’. Some religious belief systems are more threatening than comforting, offering a stern father figure who is ready to send down fire and damnation for not towing the line. I’ve worked with abused children who have this kind of earthly father and they receive little comfort in this life. To think that there is a God like this is cold, indeed.  With the threat of a fiery hell in the afterlife, or other forms of punishment for being human, it’s easy to find a lot to be afraid of.

Furthermore, some religious belief systems depend very much on social control of the people in their congregation such that if a believer doesn’t follow strict rules, they are liable to be cast out of the group or punished in some other way. There is scarce comfort to be found there as well. One can easily understand why there would need to be a veneer of perfection created and maintained at all costs. Should anyone peek underneath the surface and see the imperfect human beneath, there would be a steep price to be paid.

When I do my initial assessment session with clients, I always ask about their spiritual beliefs, especially if they have anxiety. What I have found is that many people just don’t think about this stuff. Not really. I cannot count the number of clients I’ve had over the years who are terribly anxious about death, both their own and the potential loss of loved ones, but they have never examined what they believe to be true about death and dying. Considering that death is pretty much everyone’s end game, that doesn’t seem prudent to me.

When we talk about their anxiety and I help them peel back the layers of their conscious thoughts so that the unconscious beliefs can be revealed, I’m usually not surprised to learn that many folks just hit a roadblock once death enters the picture. I’ll ask a ‘what would happen’ type question, they’ll give the ‘I could die’ answer, and then when I ask ‘and then what would happen’, they get this blank expression. They literally do not understand the question. So I’ll regroup. I’ll be direct. “What will happen to you after you die?”. There is almost always a pause, even with very religious people. Then comes the big, ‘I don’t know.’ And there it is. 

In case you are curious, here are a few of the more common core beliefs people have that live below and give support to anxiety. All of these were reported to me by adult clients, although you will notice a certain child like quality in many of them:

1. God is displeased with me. God disapproves of me.  God is disappointed in me.
2. After I die, I will be alone.
3. After I die I will get lost. After I die I will not know where to go.
4. After I die there will be nothingness.
5. After I die there will be nothing left of me. (I will be completely gone from the whole universe.)
6. I will go to hell, or at least, I’m not sure I will get into heaven.
7. God does not want me. I am not perfect enough for God.
8. After I die I will kind of float around until I find a place to land. (This has to be my favorite one, although I find it to be very sad to actually think about it.)
9. When I die I will be cast out.

You can imagine that if you held one of these beliefs, death would be a fearful thing even beyond the fear of loss and separation that we all have. I mean, it’s a natural thing to not WANT to die, to try to avoid dying too soon. That’s different from being afraid of what happens afterwards.  You can, perhaps, see the link between these underlying beliefs and the desire, the need, to try to control everything in order to create a feeling of safety and security.

On the other hand, if you believe that death is a natural part of life and that in some way you will ‘be okay’ after death, you are in a better position to live gracefully in this world of what sometimes feels like chaos. These beliefs are part of what allows us to handle going into any kind of ‘great unknown’ , like crossing oceans, or even driving in Seattle traffic. We know we can prepare but that in the end we cannot control. In the words of Helen Keller, “Security is mostly a superstition..Life is either a daring adventure, or nothing at all.” We must accept that on some level in order to live life to the fullest.

Our belief systems, whether they are Zen, Zeus, or Zoroastrianism, help us make sense of the inevitable losses that we will all face in our lives whether through our own death, or through the death of loved ones. It doesn’t matter whether what we believe is ‘true’ or not. It matters how our beliefs make us feel. Do they make us feel safe and comforted in our mortality? Or do they scare the crap out of us? I don’t know about you, but I like to just say ‘no’ to belief systems that just feel wrong and frightening. I’ll take my chances that I’m doing the right thing by following joy, not fear, which everyone knows is the enemy.

I want to make the point that what counts here is that you are comforted by the beliefs you have. After all, this is not an academic exercise. This is not a ‘knowing’ in the head. It’s a ‘knowing’ in the heart. For instance, I know some people actually believe that there is nothing at all after death, we just cease to exist. Perhaps this works for them. They may find some comfort in it. Some people believe in a literal heaven and hell and they find comfort in that. So I’m glad that’s available for them. Others believe that we live many lives either concurrently or through reincarnation. That works, too.

There is no one spiritual belief system that has the corner on the market for reducing anxiety, although there are some that are more likely to actually create anxiety than others. It’s an individual thing and, after all, we’re talking about faith here, not fact, because no one is really going to find out the answer to the big existential questions until they die. And maybe not even then! But if you have anxiety that runs your life, ask yourself what belief systems run your anxiety and see if some of those may be existential in nature.  Ask yourself the hard questions and begin to seek answers for yourself that make sense to you. Go with the answers that comfort your anxious mind. If you lead your search with your heart, you cannot go wrong.

Thanks to all the readers who stuck with me through this A to Z Challenge! I’m ready for a little blogging break now. If you need a link to the first post in the challenge, here it is.

So you have anxiety, you use your coping skills to the best of your ability, and you don’t want to go on pharmaceuticals, but you still suffer. Does that mean you are out of luck in terms of giving your brain a little gentle support? No, not at all. There are good supplements that in many cases can help cool things down for you.

First and foremost, the usual disclaimer. Please recall that I am not a doctor and I do not play one on TV. This information is the result of my own studying and my experience with both myself and with clients. If you want to try something I talk about, you are responsible for your own decisions as a full fledged grown up. (And if you are not actually a grown up, then please go talk to the adult responsible for you before trying anything.) If you have any concerns, check with your doctor.

In fact,  if you have Generalized Anxiety, that is anxiety that is pervasive over many parts of your life where you are always tense and worried about many things, you owe it to yourself to get a good physical exam. This is especially true if you never had it before, but now you do. Anxiety like symptoms can be caused by thyroid issues, adrenal gland issues, and only the lord knows what else. Get all the bloodwork done. Don’t forget that caffeine can really make it much worse.

The other thing I’m going to suggest is that if you decide to try any of these, choose a day when you don’t have to go anywhere or operate heavy machinery, like your boat. Until you’ve worked with a supplement, you don’t really know how your body will respond. I would start with the lowest dose, observe yourself, then you can add more if you need to. You want the lowest possible dose that gives you a therapeutic benefit. Unlike pharmaceuticals, there is no ‘standardized’ dosage for supplements. This is both a blessing and a curse. It truly means that it is completely up to you.

Okay, now for the good stuff. I’ve included some external links to sites that I think have good information, even if some of them sell products.

1. L-Theanine – I love this supplement. Theanine is found in tea, both green and black, and has been studied combined with caffeine as a way to help people focus. It works for that, but without the caffeine it’s a good natural anti-anxiety.  Here’s the caveat: you need to take it regularly in my experience. Unless you are taking it for a specific event, such as before a test or before leaving the dock, taking it regularly can allow you to reach a generally calmer state overall and give you more flexibility when something stressful happens. Anxiety is kind of like pain. Staying on top of it is your best bet. Once it spikes, it’s hard to bring it down. Try starting with 100 mg and rate your level of tension when you take it. After an hour, rate your level of tension again and see if it has gone down. Then take another 100mg, wait and hour, and do the same thing. This amino acid is safe, has few, if any, side effect, is cheap, and it works for many people.
2. Catecholacalm – This supplement is designed for people who have had long term, chronic stress which has led to symptoms of anxiety due to adrenal fatigue. I first found out about it when a local naturopath prescribed it for a client who had classic symptoms of anxiety and was under a lot of chronic work stress. This stuff worked wonders for my client. I have since known several other clients to benefit from it. It’s a bit more expensive than the L-theanine, which it contains. 5-Htp – Sometimes anxiety is a symptom of low serotonin, especially if the person has many symptoms of depression as well. It is very common that depression and anxiety co-exist.  There has been more interest in research on 5-HTP in Europe and Canada where pharmaceutical companies have less political influence. It’s actually a very good, well documented natural anti-depressant that increases serotonin. Interestingly, there is some research that indicates it helps with Panic Disorder. Most of the first line medications for anxiety, besides tranquilizers, are anti-depressants that increase serotonin. So it may be worth a try for you. As always, start with a low dose and work up.
3. SamE – SamE is a very good stand-alone anti-depressant and will also work for anxiety as some of the same neurotransmitters are involved. It has also been shown to help SSRIs such as Zoloft to work better so people may be able to take a lower dose. The only problem with SamE is that it is expensive. Costco has a good brand and the best price. I generally suggest trying other, less expensive things first. But I guess you get what you pay for. It’s a good supplement. If you have bipolar disorder, you should definitely check with your doctor before taking this. SamE is powerful medicine. Too much is not a good thing. I really like this blog post about SamE. (That entire site is rich with information. Just excellent.)

This is certainly not an exhaustive list and is meant to give you a place to start if you are looking for ‘natural’ solutions to anxiety. Again, I include only those supplements with which I have personal and professional experience. Anxiety is often associated with other conditions that result from inflammation, so a well rounded supplementation with anti-inflammatory vitamins and minerals such as Vitamin e, fish oil, B vitamins and magnesium may help some people feel better. If you are kind of geeky and love information, this blog on Evolutionary Psychiatry is awesome. Where has it been my whole career?

In addition, there is ground breaking research on how our gut flora effect mental health issues like anxiety and depression. It’s been discovered that some of our gut bacteria actually produce serotonin. Low serotonin is indicated in many forms of anxiety, as well as depression. This is so exciting to me. The idea that the gut is our ‘second brain’ is something that gives me a lot of hope for treatment for future generations.

Join us tomorrow for the final post in the A to Z Challenge! If you want to read from the beginning, go here.

Yesterday I was sanding teak on Galapagos when suddenly a large splintered area stabbed my finger, ripping it open and possibly leaving a nasty splinter deep under the skin. I can’t tell yet. The finger is still too tender and raw to really know until the swelling goes down. It happened so fast! There was a lot of blood. If I had xeniatrophobia, I’d be really worried about infection because it would mean I’d have to go to some doctor I’ve never met before. This phobia is the fear of unknown doctors.

Actually, if I had this fear, I’d be even more worried about sailing outside of Commencement Bay in Tacoma. I don’t know any of the doctors we might encounter should we need medical care while we are away from home. Good thing this is a fear I actually don’t have. But I do get a bit concerned about getting hurt or ill while we are doing a passage across the ocean.

Not really in denial, just enough worry to motivate me to action.

We’ve lived in the same general area for 30 years, which is so weird to me I can hardly believe it. When we go sailing we will be leaving behind our carefully chosen medical providers with whom we’ve had good relationships over many years. Here at home, if I have a medical concern, I know who to call and how to get to her office. If there is an emergency, there is a hospital down the road.  What will we do if we need medical care when we are at sea? I can get into the nice protective space of denial on things like this because on some level, I just do not think that’s going to happen. Then I do things like rip my finger open with no warning. That’s how accidents happen, generally. With no apparent warning. Amy G. Dala begins to awaken and begins spinning her dark web of fantasies. What if someone breaks a bone? What if someone cuts themselves badly? What if? What if?

Just shut the hell up, Amy, right?

We always want to be as independent as possible and medical care is no exception. As is the case on all other things like the engine, water availability, food, etc, we will prepare to the best of our ability and then, we will have to let go and just make the leap. By way of preparing, we will both be taking at least one marine first aid course designed for people who are going offshore. There are also wilderness medicine courses like this one, but it’s more expensive. Still, might spring for it as it looks comprehensive. Anyone taken that class from Longleaf Wilderness Medicine? 

Second, we will have a fully stocked medical kit on board. I will work with my primary care provider to get medications we might need and instructions on using them. There are many lists of medical supplies for cruisers that we can use as reference for buying supplies. As usual,where there is a need, someone has found a way to fill it so you can buy prepared medical supply kits designed for cruising in mind. I have not decided about this. The convenience of buying something already put together may trump any money I could save by putting it together myself. Any suggestions from experienced cruisers out there?  Some people even carry things like intravenous equipment, but since we are not trained medical personnel, I’m not sure we’ll be doing that. On the other hand, if it’s available, we’d have it to share with other people, or with a cruising doctor or nurse who would know how to use it.

We will also carry paper copies of first aid books like this one. There is a free PDF of the third edition of A Comprehensive Guide to Wilderness and Travel Medicine, a similar book by the same author, but without the marine emphasis, if you want to download it. I like having paper books for quick reference. Thumbing through my kindle to find the right page is not something I want to wrap my brain around in an emergency. 

Third, we will have a sat phone like the Iridium Go or the Delorme Inreach. These two sat phones are a little like anchors. Everyone has their favorite. Not many have used both. So we will just choose and let it be done. We’ll leave with the phone number of someone we can contact for advice in case of an emergency. In fact, my primary care provider offers services via skype, so if I need to talk to her, I can probably set something up. The chances of something that difficult happening during an actual passage are probably less likely than Amy G. Dala thinks. I mean, the longest passage we’ll likely have will be about 5 weeks depending on wind.  This is one of those times when you just prepare as well as you can, then trust and go.

Because people all over the world get medical care, I am not overly worried about finding a qualified doctor or nurse, or even dentist,  if we are in port. There is medical care of some kind almost everywhere and we are both in good general health (knock on wood, throw salt over the shoulder, spit three times and sacrifice a number of virgins if I can find them). Being a member of the Women Who Sail FB group has relieved my mind about this on a number of occasions as women post questions about who to go see in this port or that port, all over the world, and receive detailed answers with phone numbers and even offers of assistance getting to the office. It’s a great resource, although there are other cruiser resources as well, such as Noonsite. The great thing about the cruising community is that there is a network of people who know where to go and how much it’s likely to cost (hint: much less than it does here in the United States).

Do you know anyone who has xeniatrophobia? If not, teach the word to any children in your vicinity so they can wow their friends with their word knowledge. The young children of today are the word geeks of tomorrow.

Hey! We are almost finished with the A to Z Challenge! But you may have just joined us and want to read about anxiety from the beginning. Here’s a link to the first post.