Life Health & Wellbeing

Why we have to face up to the monster of anxiety

She is reluctant to call it an ‘epidemic,’ but psychotherapist Stella O’Malley is very clear that we need to deal with the disorder of our age: anxiety, writes Emily Hourican

Psychotherapist Stella O'Malley. Photo: David Conachy
Psychotherapist Stella O’Malley. Photo: David Conachy
Meaningful activity
Face up to underlying problems
Put your phone away

‘Is this the age of anxiety? Or are we pathologising it? I think it’s both,” says Stella O’Malley, psychotherapist and author of Fragile: Why We Feel More Anxious, Stressed And Overwhelmed Than Ever (And What We Can Do About It), a book which is – and does – exactly as it says.

“I think people are more anxious than ever before, but I think we are over-diagnosing it as well probably. For a long time, even up to 10 years ago, people would come in with depression, addiction, lots of other issues. Now, anxiety is ubiquitous. Every single person who comes in has anxiety, and also whatever else,” she says.

Certainly the stats would seem to bear this out: Anxiety disorder is the most common mental illness in Ireland, the UK and America. Roughly 18.1pc of Americans have been diagnosed with an anxiety disorder. There has been a 1,200pc increase in diagnoses of anxiety since 1980. That is not happy reading.

The problem – one of them, anyway – is that anxiety is infectious. “The thing about anxiety is, if I’m anxious about something, it’s my primal urge to make you anxious,” says Stella. “Because either I’m a fool for being anxious, or you’re a fool for not being anxious. Either way, I need to get you on board.”

This, she says, is responsible for the kind of pre-Leaving Cert panic that can sweep through a peer group, but it’s also one of the reasons behind a rise in anxiety in children. She is, Stella says, meeting parents who say ‘I’m anxious but my child is that little bit more anxious’.

“There’s too much anxiety. It’s spreading so intensely. That’s why I wrote this book. The book isn’t just for people with an anxiety disorder. It’s for the likes of me and you who are feeling stressed and overwhelmed and thinking, ‘I shouldn’t feel as anxious as I am, but I really am very, very anxious…’ The ‘anxious well’, you might call us?

“An awful lot of my clients would be 40-something mothers, and they are very anxious. They are very anxious about the fact that they’re anxious. And very, very anxious about the idea that their anxiety is spreading to their children. It’s awful. I don’t like to be extremist and headline-y and ‘this is an epidemic’, but I think we have to deal with this.”

A combination of a few factors has created what Stella calls “a perfect storm” of anxiety. “When news turned into entertainment in the late 1980s, they had to make it compelling, to keep us watching, and one way to do that was to make it more scary. At the same time, we went into this spiral of expectation. We’re living very high-expectation lifestyles, and we’re working very hard to achieve these. And then of course, phones, being always connected, always ‘on’. But also,” she points out, “we lost God. We lost religion. That kept a certain level of philosophy in our lives, reminded us of something other than work. I’m not religious at all, but I think it’s a lack that we don’t have a deeper place to go since we’ve lost God.”

Interestingly, although anxiety is very much a modern ailment, it is not distributed equally – in fact, the English-speaking countries (Ireland, the UK, America, Australia, Canada New Zealand) are worse in terms of mental illness – running at around 23pc of the population – than the French, Germans, Dutch, Spanish and Italians, where 11.5pc is the average. This would suggest that there isn’t an inevitability to our anxiety. It can be managed and mitigated by the culture we inhabit.

Fragile is Stella’s third book. Her previous two, Cotton Wool Kids and Bully-Proof Kids, are concerned with children and parenting, but her robust and common sense approach are the same. “I am direct,” she says with a laugh. “My style is very much the presumption that we’re all ultimately able, and that life has got in the way, and we lose our way and how we can be reminded that we’re able, and how to be able.”

As part of this, she is scathing about ‘safe spaces’ and ‘trigger warnings’, and adamant that we face our fears: “All the research shows us that avoidance of our troubles gives us short-term satisfaction, passing relief of our anxiety, but it adds to our long-term stress and anxiety. Avoidance doesn’t work – it causes more pain.” She believes that by chasing avoidance, “we are making ourselves fragile. More than anything, the book is trying to talk about how we are weakening ourselves. People are weakening themselves by following their emotions, rather than giving space to them, and then looking at rational choices”.


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We have, she says, gone “from sweeping our feelings under the rug, to putting them dead centre of our lives. We have over-corrected. We have swung too far, we need to swing back – feelings are equally important to facts; no more and no less.”

So how did she come to psychotherapy? “I was an unhappy kid. I hated school, and even though I was good at it, I was massively turned off it because of my horrible secondary school (although I liked my primary school), and my academically obsessed family. I grew up in Blanchardstown, and I dramatically moved out of home at 17 on the day I finished my Leaving Cert in 1992 and I went to live in town for the next 10 years or so. I became a street trader for a few years, and then I had a vintage clothes shop in Temple Bar – Reckless – I was so happy doing that. I loved it and it was a great success. But after a while it seemed a bit vacuous. I felt I wanted something deeper and at the same time, I wanted to move down the country. I wanted a change of life and I knew that even though I like business, I needed to do something that I felt made a difference to the world, otherwise, what was the point?”

She moved to Tulla, near Ennis, aged 27, “it was as random as my move into town at 17, with no plan and no idea what I was doing next,” she says. “I only lived there for about six months as I met my husband-to-be, Henry, around about then and moved to Birr and lived with him.” For a time she “dabbled” in local radio and “very much enjoyed it but again, it seemed a bit vacuous. Then one evening, on a whim, I attended an open evening for a course in Counselling and Psychotherapy. I was immediately transfixed and from then on, I had found my path”.

She studied at the National Counselling Institute of Ireland (now the Irish College of Humanities and Applied Sciences, ICHAS) in Limerick, and first did a diploma in Youth Studies and Psychometric Testing, then a degree in Counselling and Psychotherapy and a Masters in Cognitive Behavioural Therapy (CBT). “I loved every minute of it; it was a pure joy for me.”

Psychotherapy wasn’t totally out of the blue. “I remember saying to my brother when I was 15 or 16 – ‘I think I’ll be a psychologist’, and he said ‘really, you? I don’t think you’d be very good at it’. And I can see why he said that. I would have been very bolshie, very rebellious – I’m not the ‘how does that make you feel?’ type.”

So there was that early inclination, and then there were a series of “appalling” experiences visiting psychotherapists as a patient herself. “I visited a lot of psychotherapists in my 20s,” she says with a laugh. “I used to look at them and think, ‘man, I could do this better. I don’t even know how to do it but I can see you’re doing it wrong; you’re not bringing me out…'”

“In fact,” she continues, “I don’t think you’ll ever get a psychotherapist, psychologist, counsellor whatever, who hasn’t gone into this career [motivated by their own psychological questions]. And I would fundamentally worry about the ones who say they didn’t. I mean, why would you be involved in this industry if you weren’t very much interested in the impact on your own mind?” And indeed, persuaded by the process.

“The fact that I became a psychotherapist made me a happier person,” Stella says.

For a large part of her childhood, Stella wanted to be a boy. “From as far back as I can remember, I wanted to be a boy, and it was a very intense experience. I was very deep in that. I wasn’t a normal ‘tomboy’; I was so dismissive of tomboys – I thought, ‘they’re just girls! They’re just dabbling’.”

She hit puberty, “and I realised that nature was much bigger than me. It was a train wreck. Puberty was awful. But very slowly, I moved beyond it, from puberty onwards, only because I had no option; back in 1984, transexuality was not an option. I didn’t have that option, and so I didn’t go there, and ultimately I became very happy with who I am.”

Married to Henry, and the mother of two children, Stella says of her own journey, “I don’t think it’s revolutionary, because gender-dysphoria, if you look at the stats, 70-90pc of children are me. They grow out of it. Some people don’t. For those who don’t, they should transition and they should be supported in every way possible to transition.”

Earlier this year, she made a documentary for Channel 4, Trans Kids, exploring these very ideas, with the background of her own “intense, weird experience”. It is an excellent film – measured, tolerant, comprehensive, and was much admired. However, the topic is explosive, and inevitably there was a reaction from trans-activists who felt the film questioned their rights.

“I expected that,” she says. “Channel 4 had me trained to within an inch of my life, and frightened me to within an inch of my life, about the response. But it’s a very small minority.”

In general, the response was very warm. “I’m really glad I made it. I thought, if I could help kids who were like me… And by God I have. I’ve had so much contact, so many trans people saying, ‘it’s great to see a reasonable piece of debate’, so many parents of trans people getting in touch.”

Making the film gave her a depth of insight into the idea of no-platforming. That means, she says, “the ‘pro trans kids’ organisation we contacted shut down and wouldn’t speak to us. It was shocking. It’s amazing how people put up their protection and think not speaking is a solution.” This, of course, goes right back to her certainty that avoidance is not the answer. “It is much more empowering to speak to people. When we actually turn and face the fears, we feel stronger and more empowered than we ever did by avoiding them.”

So what can we do to confront our anxiety and begin to reduce it?

Stella isn’t a huge fan of some of the currently popular methods – the ubiquity of mindfulness, for example. “I like mindfulness, but I think it’s been very badly abused. It’s been monetised, and I hate the self-absorption; research would back me up here: if you want well-being, you have to think of other people. Altruism is an element of well-being.”

Then there are the mental health messages: ‘listen to your gut’, or the idea that ‘it’s good to talk’. “I think they were brilliant to begin the conversation, but now we have to develop the conversation. I nearly shudder when I see the phrase ‘talk to someone’, because if you talk to the wrong person at such a vulnerable moment, it’s so damaging and can leave you feeling much worse.”

The big point of the book, Stella says, “more than anything, is that short-term strategies might be very satisfying, but they’re like eating junk food: “Oh, I feel much better after the walk. And the walk is very important, the mindfulness is very important, the talking is very important, but if they are just allowing you to continue your messy life, they are not actually helping.”

This is where she delivers some very tough truths. “One of the problems with anxiety is our shallow lives,” she says. “If you’re suffering with anxiety, it may be that you need to go a little deeper. If you’re worse than you were three years ago – you’re doing more strategies – then it’s time to look at the monster under the rug.”

By which she means, looking long and hard and unflinchingly at our lives – the way we work, how much we work, the way we connect, how we live. And yes, “that’s terrifying. And difficult. And yet, one day, we’ll all be on our deathbeds thinking ‘did I enjoy that?'”

Fragile by Stella O’Malley, is published by Gill Books on April 5, €16.99.


The ‘Anxious Well’

Managing anxiety before it becomes a full-blown disorder

Go on a long-term mental well-being diet: Like bad eating habits, anxiety can build mindlessly and you will need to make a commitment to your well-being to ensure that you reduce stress and anxiety in your life.

Rediscover the favourite activities that have always freed your mind: This might be pottering about in your pyjamas or returning to yoga; there is no ‘one size fits all’. We all need to find the specific activities that do it for us.

Put your phone away

Learn some good tech management. Going online is like stepping into a different environment and it can take a moment or two to get your sea legs. Many people mindlessly check in and out of cyberspace all day, every day, underestimating or dismissing the dizzying impact this is having on our psyche. To combat this we can: Ban mindless checking and make ‘going online’ a decision. Declare certain rooms in your home ‘tech-free’. Make sure certain times of the day are tech-free, eg 10pm-8am. Learn how to turn your phone off once a day – even for 15 minutes.

Face up to underlying problems

Dare to look at the ‘monster under the rug’: Have the courage to address the underlying problems in your life. 

Meaningful activity

Forge meaning in your life: If you can focus on meaningful, goal-directed activities that feel good for your soul, you will feel less anxious than if you spend time on aimless, meaningless activities that make you feel a bit uneasy afterwards. Seeking meaning isn’t helpful because it suggests that we dash about, bouncing from mindfulness to exercise to education looking for ‘an answer’. By contrast, forging meaning entails looking at your life as it is now and finding meaning within that. So you examine what is important in your life, who you love and what sort of impact you wish to make in this life, and you work with that.

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