Anxiety Disorders and Worry: An Important Distinction

With the recent release of my new book, Anxious: Choosing Faith in a World of Worry, I want to address a possibility that its message may be misinterpreted, especially by those who have not yet had a chance to read it.

Specifically, I’m concerned that people may get the impression that my book condemns or offers a purely spiritual prescription to those affected by anxiety disorders. This would be an ironic and hurtful message in the wake of my previous book, Troubled Minds: Mental Illness and the Church’s Mission, which advocates for the church to reject this very approach to mental health issues.

I’ll summarize this concern with an excerpt from an email I received earlier this year, after my book was added to the publisher’s website in anticipation of its release. The person who sent me this email was responding to (and quoting) some of the language used in promoting the book. I really appreciated her feedback and the opportunity to have a conversation with her:

“Dear Amy–I have recently become aware of your advocacy regarding mental illness, and have appreciated the way you are helping Christians to become more aware of and educated about this issue. I have subscribed to your blog, and just began to read your most recent post about the new book you’ve written. I look forward to reading the book. But I was concerned about the following:

‘God really does care about our worry. He is offended by it, and he has made this abundantly clear throughout his historic relationship with humankind. But he always gives us a reason not to worry. And that reason is firmly planted not in a denial of the world we live in and all the reasons it gives us to worry, but in who our God is.’

I have had a similar reaction when I’ve heard a pastor or teacher say that worrying is a sin. My daughter has dealt with severe anxiety and depression. She has worked very hard to become healthy. She knows she worries excessively and irrationally. She is aware that she has a mental illness, but still has trouble with guilt. I have dealt with the same illness, but to a lesser extent. We have both received help from prayer, prescription drugs and therapy. But it is very difficult to hear someone say that God is offended by a mental illness. Perhaps you are speaking of general worry, the kind that affects many people. However people who worry have differing abilities to control their anxiety. Where does general (somewhat controllable) worry end and mental illness begin? Where do you draw the line? How do you say some who worry are offending God, and others who worry are not? Or perhaps you believe all worrying offends God?

I agree that our God gives us many reasons not to worry. As you say, His character is the main reason. But someone who has a tendency to worry, whether it be due to mental illness or not, will not be helped by being told they are offending God. I believe our God is big enough to understand the worry of His people and not be offended by it. People dealing with mental illness do not need another reason for guilt or self-loathing. They have enough trouble with the reactions of people around them without having to worry about offending the God who loves them so much He died so they could be reconciled to Him.”

Because of my heart for people affected by mental illness, I want to clarify that this book draws a clear distinction between anxiety disorders and the choice many of us make to worry. It’s ironic that we so often judge people with anxiety disorders, embracing the stigma attached to mental illness, and yet fail to address worry in the lives of those of us who actually choose to worry. This book is written mainly to an audience of people who do not have anxiety disorders but who engage in worry and have a choice in the matter. The last thing I want is for people with mental illness to feel judged, alienated, or hurt by the message of my book.

In thinking about worry, we often confuse it with two other states of mind: fear and anxiety. The three concepts are often mentioned interchangeably, but they are different and should be thought of as such. Fear and anxiety are normal, healthy, and productive capabilities God has given us–they protect us from danger and help us make wise decisions.

There is a subtle difference between fear and anxiety, and it’s not in the emotions themselves; it’s in what they’re responding to. Fear is a response to an immediate (real or perceived) threat. Anxiety usually appears not in the face of an immediate threat, but in anticipation of something that will or might happen. In general, fear is a response to an immediate and known threat. Anxiety is a response to a possibility. Physiologically, fear and anxiety can look the same. Both give rise to the physical response commonly known as “fight or flight.” Both can help us in the short term and hurt us in the long term.

Again, both fear and anxiety are normal, healthy, and helpful responses to danger and trouble. But neither is a healthy place to stay. Worry enters the picture when we choose to stay in a place of unease. Unlike normal anxiety, worry is not an involuntary physical response, but a pattern we choose to indulge. It rises not from outside ourselves, but from within. Whether or not we are conscious of it, worry is an action. It’s a choice we make, to stay in that place of anxiety that was designed to protect us from immediate danger, not to see us through everyday life.

For some, though, staying in a state of anxiety is not a choice. It’s a disorder that rises when the body’s healthy, helpful biological process works overtime. An anxiety disorder is, essentially, too much of a good thing, and it will happen to 29 percent of us at some point during our lifetime. While people with such disorders often feel ashamed and suffer condemnation from those who misunderstand, it is merely a healthy, God-given process that’s working too well. An anxiety disorder requires treatment with medication, counseling, or both. It may also require spiritual change, but an anxiety disorder is not an indication of a lack of faith or any other spiritual weakness. This condition is very different from voluntary engagement in worry.

In the book, I do make what I hope is a strong and clear distinction between those who have anxiety disorders–and therefore are unable to control the anxious response, at least to some degree–and those who are choosing to worry. I also explain the distinctions between fear, anxiety, and worry. People who choose to worry rather than trust God are engaging in a rejection of what he offers us. And I believe changing this habit begins with changing what we believe about God. But theology alone is not an effective or humane treatment for anxiety disorders–I would never suggest that.

For people with anxiety disorders–their brains and bodies stuck in a physiological process God created for our good but did not design us to live in–therapy or medication or both are required. For others, worry is a choice, but true change still requires intervention. Counseling can help, but any solution must include spiritual transformation, including an understanding of God’s tremendous grace. Voluntary worry ultimately cannot be overcome with sheer willpower–its solution is rooted entirely in who God is. It’s rooted in what we choose to believe.

  1. Mary says:

    Thank you for making the distinction. I’ve have a severe anxiety disorder most of my life and have felt guilty and ashamed because of it – thinking about verses like Phil 4:6-7. I have always felt like I’m failing as a Christian. This makes me feel a little better.

  2. Rick says:

    I have suffered as well from depression and severe anxiety for most of my adult life. Feelings of guilt and shame make my Christian walk difficult. Like Mary, I feel like I’m failing as a Christian. Mental illness affects thinking and thinking affects actions. I appreciate your compassion for those who struggle with this issue in their lives.

© 2014 Amy Simpson.