Fear was intended to be useful. A prehistoric woman wouldn’t have lived long if she wasn’t afraid of the Dire wolf sniffing by the mouth of her cave as night fell. Fight or flight, the system of self-preservation, had only one safe choice against this threat. Flight meant survival, crouching in the crooks of the cave with her body curled behind where a wall of stone elbowed into the empty space. The woman’s sympathetic nervous system would be in overdrive, the hypothalamus bitching to the adrenal glands and triggering them to release adrenaline. But when fear evolves past this healthy point, when its use as a survival tactic against the wolf has been spent, it stops being useful.
It starts becoming anxiety.
There’s an ancient legend about two wolves, rooted in the stories of the Cherokee people. A grandfather sat on a stone by the fire to tell it to his grandson, flames licking at where the bark managed to stay dry in the rainy season.
“Two wolves are fighting inside all of us,” said the grandfather in the gravel voice of somebody long past their prime. “One is a big, bad wolf. Its fur is as dark and matted as mud, snarled all the way up to its soot-black eyes. It lives in the shadows, kills whatever it finds. The other wolf has a pelt like snow, and its eyes are blue like the beads around your mother’s neck. This wolf is good and kind, breathing life into the world around it.”
“Which wolf wins?” asked the boy.
“The one that you feed.”
I’ve been feeding the wrong wolf since I was in middle school. My mother told me this parable once, like it might help me in some way. Like I could so easily switch from feeding the wolf that made me bad to the one that would make me good again. My childhood confidence was already fried to a crisp before I turned 12, crushed between canines.
We didn’t know that most anxiety disorders develop around eleven, one of the earliest timestamps for any psychiatric disorder. We had no idea that women are twice as likely to develop anxiety than men, or that the heritability of generalized anxiety disorder is sitting pretty at 30%. My extended family hosted a litany of mental illnesses that I learned to check off on hospital forms, from anxiety to substance abuse to bulimia.
Do the math.
I don’t remember when the fight began for me. With genetic anxiety, it’s not linked back to a traumatic incident. It doesn’t have a start date. Scientists are still unsure why mental illness begins expressing itself, why one twin can have schizophrenia and the other won’t. They say maybe it’s some play on environmental factors and development. Maybe that inherited disorder is lurking in your genetic potential, silent in the phenotype until it comes to term. Relatives with anxiety become risk factors in your DNA. Somewhere inside of me, the twisted strands of biological potential for a beast of an illness were waiting to pounce.
What the field of psychology has decided is that anxiety and hypersensitivity of the amygdala in the brain are positively correlated. This means that as one goes up in frequency, so does the other. Remember the hypothalamus? The amygdala is adjacent to it, buried deep in the frontal lobe of your brain. It serves as the center for emotion, moderating the behavioral expressions of feeling. My little amygdala was destined to be an overreacting piece of shit, the emotional-processing hub of the brain in constant overdrive.
Picking a wolf to feed isn’t as simple as it sounds.
Environment plays a part in the development of anxiety, the battle of nature versus nurture no longer with a winning side. I was lucky to grow up where I did, in a big Catholic family who met every need and reasonable want that I had. Emphasis on the “Catholic” part. My amygdala started losing its marbles around the time I turned twelve, which was also the same time I started learning more about Catholicism. The promise of Christian salvation became synonymous with the threat of eternal damnation. Psalms of faith twisted themselves into shadows of expectation too wide for me to fill. Tradition evolved into suffocation, commandments into internal chaos.
It wasn’t just religion. I used to get a math problem wrong and spend hours on my bedroom floor in tears, curled up in fetal position like I’d never left the womb.There was a thick brick in my brain stopping me from understanding basic algebra.I decided this made me incompetent. Not good enough. Never good enough. Bad student, bad daughter, bad person. The wolf gobbled up every algebra problem and Bible verse like candy as my chemical torment fermented.
At thirteen, I was already dreaming about dying. Visions of tombstones danced where there should have been sugarplum fairies. If I were dead, it would be easier. There would be no game between dark and light, no more war between the good wolf and the bad. Most of all, I wouldn’t have to wonder which of their slobbering mouths was the right one to feed.
“I had a dream where I killed myself,” I told my parents one night, infiltrating their rare time alone. I’d seen the headline of my suicide on the news in a nightmare, the scene fading to my family standing by my grave. I didn’t remember how they looked, faces blurred in the dreamscape. I remember how they felt, though.
They were relieved.
The memories of what happened next have since been suffocated by the panic attack that followed their decision: I was going to therapy. Even though I didn’t feel lucky at the time (picture me bent over the bathroom sink, dry-heaving into it as I screamed at them not to take me to see a shrink), I was. For every ten people with a mental illness, five don’t receive treatment.
The therapist’s office that my mom took me to was in an old office building, the kind where panels are missing from the ceiling and never replaced. The receptionist was a lady as ancient as the Two Wolves legend, pink glasses shoved down her nose like she was trying to be a librarian.
“Who are you here to see today?”
She asked this every time, even though we came once a week. She said it like there was more than a handful of therapists to choose from, like the list of appointments had been botched and she wasn’t sure if I was scheduled with the only therapist there who specialized with children.
Like I was forgettable.
My mom and I would sit together in the lobby after that, usually in uncomfortable silence with the other patients. The only noises were nails tapping on phone screens and pages of Cosmopolitan rustling against one another. It was less of a waiting room and more of a narrow hallway that served as a temporary home to donated furniture and the mentally ill.
The door between us and the adjacent hall of therapist offices was locked for entry from our side. We had to wait for the therapist to come with a key. There was a little square window near the top of it. It was the kind they have in prisons, ones that let the incarcerated catch a glimpse of the world outside their cells.
The actual therapist I saw was much nicer than the environment implied. She had magic sand in her office, purple with sparkles between the grains. For the entire hour of the appointment, I built shapes and smashed them right back to nothing. I watched her take notes like it meant something.
On the way back out to the car, I dusted my hands off until most of the glitter was gone. No matter how hard I tried, there was always a little sparkle left when I got home.
It wasn’t long before she told me my diagnosis. One in four people are said to have a mental illness. If therapists got a hold of them, it’d be all four. Obsessive-compulsive disorder was the first name for the bad wolf, but generalized anxiety disorder followed suit. Comorbidity, or the existence of two or more disorders squatting in the same person, has a rate of 60% for those with anxiety.
I didn’t mind having two anxiety disorders. The more labels on a wolf, the more ways to defeat it.
Cognitive-behavioral therapy was the first wave of attack. It’s the gold standard for psychotherapy, more effective than psychiatric medication by a long shot — if you can afford it. Appointments without insurance soar to hundreds of dollars.
But it can work.
50-75% of people who receive this form of talk therapy say they feel better. Whatever that means. Therapists hone in on the bad wolf, the darkness that chokes the life out of your amygdala, and rehabilitate it into being good again.
My therapist tried to teach me to build coping mechanisms out of bricks rather than straw, to change my catastrophic thinking and clichéd anxiety spirals. I didn’t listen out of stubbornness (I like to restrict that trait to my childhood, but I’d be lying), and so it didn’t work. The wolf had its paws pressed against my ears until my head was a sounding chamber for its graveling echo.
You’re going straight to hell if you don’t flick that light switch exactly four times.
The volume better end on an even number. Or five. Five is okay.
You’re so anxious; do you know how bad that is for you?
You’re going to die when you’re forty from a stress-induced heart attack.
God, you’d be better off dying now.
The logic my therapist suggested proved useless as expensive weaponry with my stubborn attempts to avoid employing it. Expensive is an easy word to explain the annual $42.3 billion that’s spent in the United States alone to treat the 30% of adults with an anxiety disorder. Their therapy appointments, psychiatric medications, and other necessities cost a pretty penny, for them and their insurance companies alike.
I liked to dream about how much my death could change that number.
My therapist suggested standing up to the wolf, despite my previous lackluster attempts to follow her instructions. She encouraged me to reject the thoughts and compulsions.
“If not with logic,” she would say. “With action.”
That once, I tried taking her advice. It was summer then, one of those afternoons when the Virginia humidity fogged the glass of my bedroom window, thick as Brunswick stew. The curtains were open, purple fabric pulled wide apart so I could see the summer storm brewing outside.
I wasn’t going to do it. I had to stand my ground. Temptation sang like a siren from behind the open blinds, whispering from the rustling edges of the curtains.
If you don’t close those curtains, someone is going to die and it’ll be all your fault.
I buried myself beneath the covers until the carbon dioxide burned in my lungs. I made a gap in the blankets for fresh air to trickle into my cave as lightning flashed and thunder chased behind it with a boom. At some point, exhausted by overthinking and the lack of oxygen, I fell asleep.
Which meant I never closed the curtains.
That was the day of the 2013 tornado in Moore, Oklahoma. An EF5 tornado with winds at 210mph killed 24 people and slammed through two elementary schools. It claimed the lives of seven children. Back then, seven felt like a big number. No effort on the part of my therapist could convince me that it wasn’t my fault — and so the bad wolf snatched the upper hand.
I wove in and out of therapy for years after that. I only went back when my parents asked me to, or when my thoughts danced back into enemy territory. The topic of psychiatric medication was brought up on occasion, a possible strategy in the war against the wolf. Doctors talked nonsense about neurotransmitters like serotonin and dopamine, the effect of antidepressants in the brain.
In college, the school nurse offered me a prescription for an SSRI, or a selective serotonin reuptake inhibitor. It was supposed to block the reuptake of serotonin into my neurons, selective only for that particular neurotransmitter. The longer the neurotransmitter camped out in the synaptic cleft, the more it diffused its chemical message into the brain’s atmosphere. Serotonin neurotransmitters make you calmer. If I took this medication, they’d hang around a little longer before getting sucked up and carried away. It could make my life easier, easily.
Speaking of easy, getting this mind-altering medication was ridiculously simple. I made an appointment with the on-campus health center, told the doctor I was experiencing some anxiety symptoms that were interfering with my schoolwork and life. She handed me a prescription for Zoloft. It’s also called sertraline, if you want to be formal.
The side effects were ruthless. Insomnia kept me lying awake with my eyes closed, extreme exhaustion throughout the day that left me dozing in class, nausea from when I woke up until the time when I was supposed to be asleep, and severe gastrointestinal problems that led me to gain upwards of ten pounds during my spring semester of sophomore year.
Needless to say, I went off the drug. It wasn’t worth making myself so sick, just to scare the bad wolf away. The campus doctor never got back to me about a follow-up appointment, so I stopped taking it on my own. When I finally got in contact with the doctor, I was understandably chastised for going “cold turkey” off my meds. She said cold turkey like wet deli meat and goose-pimples were synonymous with clammy skin and withdrawal fever.
After going off the meds, I was back to having hysterical breakdowns the night before every exam. These looked like me huddled by the roots of a tree on campus, wheezing between sobs that I choked back into silence. With the wolf off its medicinal leash, I decided I wasn’t good anymore. If I had ever been. Not good enough to eat, not good enough to be around anyone. Not good enough to breathe.
All this exerted stress on my body, along with the continued malfunction of my amygdala, forged a new disorder in my intestines called irritable bowel syndrome, or IBS. For someone like me, that’s not uncommon. 56.3% of people with generalized anxiety disorder like mine report a severe impact on their physical health. A summer of blood tests and doctor visits followed to try and diagnose my new problem.
“This definitely sounds like IBS,” my pediatrician said, glancing through the blood test results. Nineteen and still seeing my pediatrician — I know. But I liked this doctor. She didn’t put me on any medications I didn’t want to be on, listened to me without diagnosing everything I was going through. This appointment was the one exception.
“I know you’ve been working with the new IBS diet since you’ve been back from school, which is great — but you can’t stay on it for long. There’s lots of nutrients it keeps you from getting. It’ll help your symptoms, but they won’t go away forever. We’ll have to start getting you accustomed to foods and see what you’re most sensitive to.”
“Is there a medication you can give me, or a diet I can stay on for longer?” I asked her. It was just me and my pediatrician that day. I was sitting on an examination table sized for a child. Puzzles were stocked on the nearby bookshelf, the kind of jigsaw where the wooden pieces won’t fit into a space they’re not supposed to. This doctor’s office was the kind of place where every single one of the examination rooms had a door of a different color. I lucked out into the blue one that day — my favorite.
This was one of those monumental first doctor appointments that college students make for themselves. My mom told me it was due time I did this stuff on my own. She was right, with the still-seeing-my-pediatrician business — but it was a tough summer not to have her with me.
“IBS isn’t curable. You can’t press the reset button on this kind of thing and be healthy again. This is something you’re going to deal with for the rest of your life.”
After that optimistic diagnosis, I went back for another semester of college. It turned out to be sixteen weeks of breakdowns in bathrooms across campus or between classes. The occasional dumpster sufficed when I couldn’t make it back to my room. Coping mechanisms from my old therapist proved no match against the wolf that was digging its claws into my ribs and the lungs those bones were supposed to protect.
I started having asthmatic symptoms daily during those sixteen weeks, straining for breath after short exertions. My body was starting to atrophy around me — and I believed I deserved it. It was nothing but penance. That’s when I found my way back to the health center, out of absolute desperation to halt my decay in its tracks.
This time, they put me on Lexapro.
There were no symptoms with the lowest dose, but it proved tough to stay on. Any mention of anxiety made the campus doctor decide to double my dosage, even when I just began adjusting to the last prescription. I learned to lie about my symptoms, claiming everything was fine and that I didn’t, under any circumstances, need a higher dose. Pretty, pretty please.
10mg made me sleepy, 20 had professors catching me asleep during class. If I managed to stay awake, I was unfocused and didn’t retain a thing. Once, the doctor prescribed me 90 of the lower dose pills for winter break. 450mg total, rattling around in that little orange bottle like tic-tacs.
I wondered how much it would take to overdose.
I still lie every time I go to her. Actual psychiatrists take months to receive treatment from, with no guarantee they’d be any better than the doctor I pay for with my tuition.
In 2013, it was estimated that 16.7% of all Americans were taking some sort of psychiatric medication. That’s one in six, to put it in perspective. The market for psychopharmacology rakes in billions upon billions of dollars, the rate steadily ticking upward with each passing year.
But taking medication itself isn’t the issue here. It helps lots of people, especially in conjunction with therapy. The issue is the over-prescriptions, those people who get psychiatric medications when it’s not needed. Between 1996 and 2007, the number of appointments where people were prescribed psychiatric medication with no diagnosable mental illness grew from 59.5% to 72.7%. In 2014, 57% of people with mental health problems were using medication as their only form of treatment. That percentage trends upward at every opportunity. Healthcare providers can pathologize human nature as sickness. They have the power to find a bad wolf when there wasn’t one to begin with and treat healthy brains like they’re sick.
“You seem a little distracted.” The doctor glanced at me over the rims of her glasses. She had them pushed down her nose like the old receptionist at the therapist’s office, back when I was little. The paper slip on the exam table crinkled under me as I shifted to meet her gaze, my attention previously focused on the posters on the wall that talked about portion sizes. Hating my body is on my long list of mental problems. I don’t have body dysmorphia just like I don’t have asthma and still use an inhaler.
“Sorry.” I said, clearing my throat. I’d learned that a serving of carbs was about one cupped hand. Servings of fats should be no longer than the length of your thumb. Vegetables got a whole fist, and proteins were blessed with the palm.
“Do you think you have ADHD?”
I startled, portion sizes forgotten. Why was she asking me what I had?
“ADHD?” I stammered.
“Or ADD. They’re fairly similar. You’ve described feeling distracted in a lot of your classes. Like it’s hard for you to focus.”
“That’s the medication.” I frowned. “A side effect. It says so on the back of the bottle.”
“If you’re sure,” she said. She reached for the pencil she kept tucked behind her ear and crossed something off of the clipboard she was holding. “You mentioned that you’ve been having mood swings, too. Do you think you might have bipolar disorder?”
“I don’t think so, no. They’re not the same kind of mood swings.”
“Mmmhm,” she murmured. Pencil scratched against paper. “We might need to adjust you to a higher dose of Lexapro. 10 milligrams sounds like it might take care of some of these symptoms.”
“It’s fine the way it is. I like my current dose.”
Pretty, pretty please.
“Prozac, then. We’ll switch you.”
“I don’t want to switch my meds, I like this one.”
The doctor was quiet for a blessed moment, staring at me until that holy silence stretched well past the point of comfort. When she spoke, her voice snapped.
“For a girl who claims to have faith in God, you don’t have a lot of faith in doctors.”
That slap slid off her tongue like it was nothing. Tears smarted in my eyes, and I had to blink them away before she could see and be proven right.
Remember when I said I needed to lie to my psychiatrist?
As bad as it is to lie for lower doses, it’s worse to face a new potential diagnosis every time I walk in the door. My example might be dramatic, but they happened. I’m not the only one. Over-diagnosing is as much of a problem as over-prescription. Instead of blaming the subset of bad therapists, or the education system, or our current societal climate of calling every off-kilter trait a mental disorder, everyone would rather point fingers at the Diagnostic Statistical Manual of Mental Disorders. Most people just call it the DSM. It’s the Bible of psychiatry in its fifth edition — every mental illness known to man, boiled down to the black-and-white.
Like most things in the field of psychology, it’s controversial. Its categorical approach is often criticized for making it “too easy” to get a mental health diagnosis. If you feel depressed for 13 days along with every other symptom listed under the criteria for Major Depressive Disorder, you can’t get diagnosed. But 14 days? Well, now your mental issues have incubated long enough to become a disorder.
“I changed your diagnosis last time we met.”
This was a different therapist than the one from my childhood, one of those “free-with-your-tuition” ones from the therapy center on campus. She was my therapist since freshman year, on and off for three semesters. I saw her every two weeks, which was incrementally increasing to be three apart. I was starved for help by the time each appointment slunk around.
I was in a crisis appointment, for Christ’s sake. It was the week before finals, sophomore year — that time of December when grass coated with frost crunched under every step. Cold fogged the windows of her office. It was warm in here, but she made it cold with eight words strung together in a sentence, not drawing a single breath between them.
She saved this cheery piece of news for the last fifteen minutes of our appointment.
My pulse hammered away, throbbing in my palms and fingertips. My bad wolf was an ancient evil to me. OCD, generalized anxiety — we were familiar with each other. I knew how it worked. We were almost old friends; better yet, estranged enemies. Maybe befriending the wolf was a better strategy than fighting with it, or praying for the good one to win. This therapist wasn’t a good enough one to tell me that — I wouldn’t learn about that option till later.
“I switched it from OCD and generalized anxiety disorder. I think there’s one that fits everything you’ve been going through, and I was going to email you about it over break. I’m glad you came in, even if it was for a crisis.”
She swiveled around in her chair, gliding through fumes of eucalyptus from the nearby aromatherapy diffuser so she could reach her bookshelf. Out came a copy of the DSM in all its glory, which she paged through after licking her fingers like she just had dessert.
“I’m going to read out some diagnostic criteria for you, okay? Tell me if you’ve experienced these things. We can talk about them, see if you agree.”
It seemed like more autonomy than the psychiatrist gave me. At least that was something. I nodded, squeezing my legs up against my chest in the chair. It was one of those stereotypical beasts that therapists adopt from Goodwill, holes worn into matted velvet. It creaked with every breath I took, sounding more pained than the inside of my chest.
“Have you had a pattern of intense and unstable relationships, swinging from extreme closeness and love to extreme dislike or anger?”
“Distorted and unstable self-image or sense of self?”
“I mean, I don’t like myself. Does that count as distorted?”
“Sure,” she said. She was leaning over the DSM, squinting beaded eyes. They were focused on the paper, not me.
“Do you engage in impulsive and often dangerous behaviors, such as spending sprees, unsafe sex, substance abuse, reckless driving, and binge eating?’
“No?” Her glasses were inching forward on her nose, pinching the bridge. “Remember Thanksgiving?”
“Yeah, the party.” I shifted in my seat, much to the shrieking protest of the chair. She didn’t have magic sand in her office like my therapist back home, so I resorted to picking at my nails as a distraction. “I made out with Devin afterwards.”
“That seems pretty reckless to me, considering you being religious and all,” she said. The eucalyptus in the air felt like it was clouding in my lungs.
“We’re friends, though. It’s not like I didn’t know him.” I cleared my throat, but it came out like a squeak.
“Coworkers, I thought. And kissing that girl last month? That’s very unlike you. You haven’t been a reckless person until now.”
My shaken silence was her invitation.
And that’s how the rest of the appointment went. By the end of it, she convinced me that I met almost every criteria in the book for borderline personality disorder. The diagnosis was declared unanimous, her and the DSM the only two in agreement. There it was, inked into the records of my history at college. I had a new wolf to battle, bigger and badder than the one I had before.
What I didn’t know then was that she was wrong. I left the appointment in tears after she wished me a “Merry Christmas” and cried in my car for an hour before sailing it over to Starbucks. I sat there in a stiff-backed chair with a cup of ice water and a swollen face for seven hours straight. I had my big headphones on, the kind that made the rest of the world sound like it
was underwater with me. Maybe the new wolf would drown in them before it could drill into my brain.
I went home after finals, scheduled to meet with my previous therapist from when I was a kid. She was shocked I was given a diagnosis of a personality disorder, arguing the impossibility of it from her years treating me. Back to OCD and generalized anxiety disorder it was. The new wolf was gone just like that, with the snap of the DSM’s closing covers.
It’s easy to say after reading that scene that mental health diagnoses are bullshit, but they’re not. It was bullshit that the campus therapist I saw misdiagnosed me with something much more severe than I was dealing with. Most therapists are much better than that. Matter-of-fact, most other therapists on my campus are. They’re in the profession for a reason — they want to help people. With the DSM in hand, they can give you labels for a wolf’s dangling collar. Anorexia Nervosa. Major Depressive Disorder. Bipolar I. Personality disorders themselves come by the barrel.
All these names can help, because they come with plans of attack. Dialectical behavior therapy works best for Borderline Personality Disorder. Lithium helps stabilize mood swings for those with Bipolar I and II. The labels are accompanied by insurance benefits, too — and that’s a very good thing. Being sick doesn’t come cheap.
At the end of the day, therapists can be good, but have the potential to mislead you in impossible directions. Antidepressants might help, but they can also hurt. Diagnoses can be weapons against the wolf, but they can be given to the wrong people. So what’s the point, to look at all this as it is? To see through my experience, an experience much better than many who find themselves in the same situation, the way I’m living with a big, bad wolf?
Because this conversation is one that needs to be had. Humanity can’t be defined in the black-and-white of the DSM’s printed pages. Psychiatric diagnoses don’t fit everyone. Therapists have biased opinions, because they’re people too. Antidepressants are prescribed as a go-to rather than a last resort — and it’s only easy to get these diagnoses, medications, and therapy if you have the means and insurance necessary. Most don’t. The resources out there are limited, expensive if you’re lucky.
At its best, mental illness is messy and so is the aftermath. But there can be goodness in it, too. Like that first good day, when your chest doesn’t hurt like it did before, when you can focus in class and feel like you’re actually learning something, when you catch yourself smiling at something you would’ve frowned through before. That’s when you start feeling like maybe the wolf is on a leash, walking beside you instead of tugging ahead at the collar.
Even in the mental healthcare system, as messed up as it can be, there’s goodness. Therapists can change your life. My current one has. I might not have figured out how to deal with my bad wolf just yet, but she’s helping. She’s teaching me how to befriend it, to give it some love from time to time. I’m finally trying to listen. Good is found in the people who devote their lives to careers as therapists, social workers, psychologists, all in the greater quest to work in the restraints of the system and help people who need it.
But as long as it’s been since the Dire wolf prowled outside caves at dusk, since the Cherokee spun the tale of the two wolves, since Disney wrote songs about the one that blew the little pigs’ houses down, bad wolves will always be here. It gets harder every year for therapists to sort between them, to weed out what’s a potential misdiagnosis and what’s not. Good wolves can disguise themselves as the bad, morphing into what they want to be in the process. White fur fades to gray, then black. It’s like Little Red Riding Hood in reverse; grandmother becoming the wolf.
Emma Snyder is a senior at the University of Mary Washington, majoring in both Psychology and Creative Writing. She is also pursuing a minor in Digital Studies. She focuses on writing about mental illness in a way that educates the public about the stigma and other difficulties those with these disorders face. Her work can also be found in the Spring 2020 issue of Furrow Magazine.