by Erin Tishman
Milly was a 65-year-old woman who came into my office complaining of persistent neck and stomach pain. She said she could no longer drive her car on a regular basis because the neck pain was so severe, and her digestive system was also suffering whenever she ate certain foods that she had enjoyed without problems her entire life.
Milly’s husband, Sal, had recently been diagnosed with amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease. It’s a nervous system disorder that severely weakens the muscles and impacts all physical function. Its progression is known to be very fast.
Milly and Sal did not have any children, and their extended family was living in the Midwest, where she and Sal had met. Milly never worked because Sal’s Wall Street job had afforded them a comfortable life, and given Milly the opportunity to spend her time volunteering and being a homemaker. She took great pride in her gardens and was always pleased to have company so she could show off her hard work.
When Sal was diagnosed with ALS, Milly became his caretaker on a round-the-clock basis, attempting to meet all of his needs — even just to scratch his back whenever needed. Milly’s life became consumed with helping Sal and, because of the rapid progression of his illness, she found herself forgoing sleep, getting only a couple of hours here and there, when she could.
Milly came to see me the week that an in-home nurse’s aide began coming to their home for two full shifts a week. In addition to Milly’s ongoing neck and stomach trouble, she had lost about 20 pounds, was looking underweight and frail, and had stopped doing the things that she loved — gardening, decorating, and volunteering at a local arboretum. Milly explained that she didn’t want to leave her home much anymore, feeling overwhelmed by her husband’s ordeal. She reported that she had been prescribed Xanax, a psychotropic medication used to treat anxiety, and was taking it only “as needed,” whenever the panic attacks set in. “Sometimes I just feel as if darkness is closing in on me and the floor is dropping out below,” Milly said, aptly describing the terror of severe anxiety. “And I feel like I need to run for my life, but my feet are locked in cement.”
Eventually, she began taking Xanax not just “as needed,” but regularly and several times a day. She reported that she didn’t feel the medication was doing much good, offering only temporary relief at best. She still felt paralyzed by the fear of an uncertain future.
Anxiety is one of the most common mental health issues in the United States. It can manifest in a number of ways, including intense physical pain; isolation; avoidance of people, settings and events that have any connection to the source of the anxiety; and persistent worry, stress and fear that seeps into your mind as though there’s a little demon on your shoulder, screaming into your ear that life is hopeless. The fear needn’t be well defined; in fact, the less definition there is, the harder it is to overcome. This is called “free-floating anxiety” – a generalized, persistent, pervasive fear that is not attributable to any specific object, event or source. It’s often the most difficult anxiety to treat, for the very reason that there are no well-defined elements you can attack therapeutically.
Anxiety is treatable, even curable, but a challenge to overcome even in the best of circumstances. Because the only effective treatment is to meet the anxiety head-on, to scrutinize the source of the discontent, examining each and every fear. Of course, you have to isolate the fears before you can scrutinize them, and that’s where therapy comes in.
In working with Milly, we managed to identify the fears of what her life might be like without Sal. He had been responsible for the household income, but he was also the man by her side for 40 years. They spent much of their free time together, going to the movies, traveling, walking in her gardens, and none of this was possible anymore. But Milly’s dread transcended simple loneliness. There was a valid fear that the cost of Sal’s care could wipe them out financially and leave nothing for her to live on in her remaining years. Still only 65, Milly understood that she could live for several more decades, but decades without Sal’s companionship, without Sal’s income, without the life she had come to know throughout their marriage. Her very existence was coming unhinged.
When experiencing anxiety, it is important to utilize talk therapy in combination with psychotropic medication (if medication is indicated). While many people want to “pop a pill” to feel better, when it comes to anxiety, medication is very different than, say, taking an aspirin for a headache. A headache is a medical condition that an analgesic, like aspirin, can rectify. Anxiety is a psychological condition, and, while medication may dull the anxiety, it doesn’t resolve it. Anxiety is brought on by the mind and its perception of events, situations, feelings, etc., so it is recommended that patients engage in talk therapy to address the mind’s discontent. Therapy allows the patient to find and understand the source of their anxiety, to identify coping skills to help manage it, and, by managing the anxiety in a healthy manner, the patient is often able to resume normal daily functioning.
Through our work together, Milly was able to see that her life without Sal would be difficult and initially very sad, but that she would be able to find solace in the things she had always loved — gardening and volunteering. She would discover a new life, one that may never match her life with Sal, but one that was manageable, peaceful, and allow her to feel happiness again.
Erin Tishman is Family Centers’ Manager of Clinical Services for Darien/New Canaan. Serving Greenwich, Stamford, Darien, New Canaan, CT, and Westchester County, NY, Family Centers is a United Way, New Canaan Community Foundation and Community Fund of Darien partner agency that offers counseling and support programs for children, adults and families. For information, call 203-869-4848 or visit www.familycenters.org.
Photo by Peter Capuciati.