The Age of Anxiety

“I have always been an anxious child,” says Adya.* The 28-year-old graphic designer grew up in a household where tempers ran short and the environment was volatile. She didn’t recognize the bouts of crying, palpitations and chest pain as anxiety until much later, when in 2019, it became debilitating after a breakup. “There were times when you would just be curled up in bed, and then you just don't know how to tell your family, how to tell your friends because you don't see them going through any of it.”

Searching for an explanation for her symptoms, she turned to the Internet, as countless others before her. After scouring through medical blogs and websites, Adya concluded that she had Generalized Anxiety Disorder (GAD). She just needed a professional to confirm it. But even after all these years, her therapist has refrained from labeling it as a disorder. “She just said that it was high anxiety. And then only after many sessions of therapy, I realized that [I] was just dysregulated – it wasn't any disorder,” Adya says.

It’s a question many of us confront at some point in our lives: is our anxiety normal, or is it an illness?

10,000 years ago, anxiety had an evolutionary purpose: it protected us. “Without anxiety, we wouldn't actually have been able to come this far in humanity,” says psychotherapist Rhea Gandhi. Our limbic system adapted as a response to an environment of tree canopies and undergrowth, predators and natural disasters. But this is not the environment we know now; we inherited our ancestors’ anxiety as proof of their survival but no longer know how to use it to our advantage. Various studies over the years also support the postulation of fear and anxiety as survival traits.

And indeed, anxiety disorders are classed under an umbrella of the most common mental illnesses in the world, with many studies confirm that a large section of the world’s population is anxious. But they’re divided on the question of whether it’s rising or not. According to one study, anxiety disorders have risen 55% from 1990 to 2019 – strangely correlated to increases in socioeconomic development and urbanization. But another study notes that roughly one third of the population is affected by an anxiety disorder in their lifetimes – and this figure hasn’t changed much over the years. “I would say that anxiety is something that we don't, even now, need to denote. Every single person I work with has anxiety,” says Mansi Poddar, a psychologist and psychotherapist based in Kolkata.

A 2020 survey conducted among 10,000 Indians found that 74% were suffering from stress, while 88% reported experiencing anxiety post-pandemic.

What we do know is that there is greater documentation of anxiety now – but does that mean greater prevalence? “We call anxiety and depression the ‘common cold’ of mental health. Most people are going to experience some form of this in their lives,” says Gandhi.

From a clinical perspective, the line between anxiety as an emotion and anxiety as a disorder often depends on who you ask.

Clinical psychologist Shreya Pahwa, who is trained in Rational Emotive Therapy, defines that line as diagnosis. But others prefer not to rely on the diagnostic term at all. “It is a biological human emotion but there are clinical realities attached to it, and there is no one way to find out where the line is,” says Sadaf Vidha, founder of Guftagu Counselling and Psychotherapy Services.

Then there is the field of trauma therapy, which views anxiety in a markedly different way: For Akanksha Chandele, a trauma-trained therapist, anxiety is not a disorder, but a natural response to a stressful situation. This response occurs by an activation in the nervous system, she explains. “If it doesn't find the right kind of regulation, over a period of time, and across a series of behaviors, it gets labeled as a disorder… this has started to gain momentum in the medical world.”

People may present with symptoms that cut across multiple anxiety disorders, explains Dr. Neeharika Jaiswal. “[T]he comorbidity can make it difficult to just assign a single diagnosis.” While it could lead to an overdiagnosis, there are chances of it missing the actual suffering underlying a condition, or misdiagnosing it entirely, Jaiswal adds. In other words, the diagnostic criteria are simultaneously too broad and too narrow, failing to encompass the nuances and different facets of an individual and their behavioral responses. There’s also the fact that the Diagnostic and Statistical Manual of Mental Disorders – considered the Bible of psychiatry – has been criticized as a restrictive framework that doesn’t apply to diverse cultural contexts.

Sanskriti Singh, a clinical psychologist who works primarily with adolescents, once had a client who had shown improvement in their last few sessions. But learning of her diagnosis from her psychiatrist set her back. Searching for more information online only made it worse, as the results told her that her condition was untreatable, leaving her disheartened. “That's another thing in anxiety disorders, that a lot of time patients just fixate on the labels, and they read stuff up online, and they make the most catastrophic interpretations of it,” explains Singh. Fixate too heavily on a label might lead to one being stuck in a loop that undoes the progress in any treatment modality.

It is undoubtedly important to speak about mental health conditions, such as anxiety and depression, but it is also important to recognize that we may be overpathologizing an everyday experience, says Gandhi. “And the problem with this narrative is that there seems to be this idea of ‘normal’ that actually does not exist in reality. And with everyone trying to reach that point, we are setting ourselves up to fail.”

We’re in a cultural moment where everything is a new type of anxiety: eco-anxiety, which has received serious attention, exists alongside, say, “menu anxiety.” On the Internet, all anxiety is treated like a pathology – leading to more apps, more supplements, and more conversations than ever.

In 2016, Nicholas Haslam, a professor of psychology at the University of Melbourne, Australia, took six concepts of harm – “abuse, addiction, bullying, mental disorder, prejudice, and trauma” – and showed how their meanings had expanded over time. These terms had inflated their range to encompass not only less severe experiences but completely new experiences as well. He called this “concept creep.”

In another paper last year, the research team narrowed the focus to "anxiety" and "depression" – the two most common mental health terms. They pored over 800,000 psychology articles published between 1970 and 2018, and extracted half a billion words from American TV, movies, books, newspapers, and even spoken English. They found that the two terms had begun appearing quite frequently near disease-related terms such as “symptoms” or “disorder.” Although the two could be “everyday mood states,” the researchers wrote, that’s not how people were understanding them. As these terms filtered into daily usage, it became more common for people to view them as clinical conditions. “People may now use these words to refer to less severe phenomena than they once did and increasingly adopt a clinical understanding of them when they do," the researchers wrote. "So the concepts of anxiety and depression may have broadened, intensified and pathologized simultaneously.”

The pathologization of mental health is now so mainstream that it has celebrity faces attached to it. Billion-dollar companies Cadbury and Maybelline launched ad campaigns called “Get the Message” and “Brave Together,” respectively (the latter with Olympian PV Sindhu) – both, you guessed it, aiming to raise awareness about mental health. Several celebrities have become the faces of mental health, simply by virtue of having lived experience – many of whom have either started a foundation, a podcast, or written a book to raise awareness and conduct advocacy. One might argue that having a rich and powerful people attached to mental health is ostensibly a good thing: it shows that nobody is exempt, not even people with everything. Jasmine Kalha, from the Centre for Mental Health Law and Policy, says that celebs speaking about their mental health openly and candidly is an evidence-based strategy to help communities deal with stigma. But where does destigmatizing end and overpathologizing begin?

We've ended up with an oversaturation of therapy-jargon on social media – especially where it pertains to anxiety. On the internet, licensed mental health professionals sit beside unqualified mental health coaches and content creators.

“Solving anxiety permanently without medicine using our 4 step method,” reads the Instagram bio of one mental health coach in India. Click on the given link and it directs you to a website with a promise emblazoned on top: “Anxiety Warriors: Your Life is about to change!” At the bottom is a ticking timer – if it hits zero, this offer of a lifetime expires. The webpage guarantees that one can “get out of Anxiety permanently” in just 28 days. That too, without medication or making any lifestyle changes. YouTube is also full of videos by self-proclaimed life coaches who claim to “cure” anxiety. “How I Cured My Anxiety Forever (My Emotional Story)” is the title of one video. The founder of one such 21-day program posted a YouTube video titled “How to overcome fear, nervousness and anxiety forever?” In the caption, there is a disclaimer: “The information on this website and techniques shared in the program cannot and will not cure any disease or health condition.”

There are even listicles for which mental health influencers you should follow. Around 12,000 Instagram accounts discuss mental health, according to an influencer marketing firm that looked at 5 lakh accounts in India.

“Instagram has a lot of people who are using the word anxiety, talking about anxiety, adding to the narrative, but they are unable to differentiate between the human experience and a disorder,” says Poddar. “So we've forgotten what is being human and what is actually a problem.”

The representation of anxiety on social media and in popular culture at large may have incorrectly framed anxiety as always unwanted. A 100-year-old landmark study on anxiety, however, found that too much and too little anxiety impair performance, but some amount of anxiety actually improves it.

“I don't think we can cure ourselves out of emotions because we need emotions to live,” says Vidha. Often, these emotions mask a deeper truth. If feelings are indicators, they are pointing us in the direction of something that needs our attention, says Vidha. This may be internal or in the environment around us. The omnipresence of anxiety, that makes it seem like an almost collective shared experience, then is a clue. “It’s about many aspects of our culture that are not working,” explains Vidha.

As Singh puts it: “Anxiety is a part of the human condition. So we're never going to be able to escape it entirely."

We might, however, be closer to fixing the structural problems that anxiety is nudging us to pay attention to. But not if we keep trying to kill the anxiety itself.

Manvi* has, over time, accumulated an array of products to alleviate her anxiety: There is a mood-boosting herbal tea set, where the powder sachets come with a tea cup, a wooden stirrer she calls a “wand” to stir the brew, and a note personally addressed to her that uses a combination of well-worn and whimsical phrases such as “self-care,” “self love,” and “elixir.” She gushes over the packaging, recounting that it’s what drew her to it – each sachet glows iridescent as it catches the light. There is a box of essential oil roll-ons – one each for “relaxation,” “insomnia,” and “migraine-relief.” She likes that they used the term relaxation over stress-relief – it’s her “preferred nomenclature,” she says emphatically. Additionally, there are melatonin supplements, crystals, and packages from a “retail-therapy” splurge.

Not all of these products work for her. The ones that do are effective mostly as a distraction, she explains. The smell of the candle. How the oil feels. The ritual of applying the oil. The act of preparing the tea. And, of course, the glitter that swirls on the surface. As she puts it, “All that glitters is anxiety-relief.”

This approach to anxiety relief is more accessible than ever today. You can now buy calm and relaxation “melts” and “mood elixirs” on 10-minute delivery apps – products that claim to sooth “psychological and physiological stress responses.” The rush to capitalize on anxiety in the wellness space – sans the regulatory constraints of the pharma industry – probably has to do with the fact that there is a huge market for it, because everyone's talking about it.

“90% people admit they are in stress due to one reason or another,” Vaibhav Makhija, co-founder of a brand that sells a range of stress-relief gummies that claim to reduce anxiety. The banner ad on their website for this product reads: “Take Control of Your Anxiety Today!” Unasked is the question: should you?

There is a growing awareness of anxiety, Makhija adds. He explains that their company is targeting people in the age group of 20-40 who are earning at least INR 50,000-60,000 a month. Their audience comprises people who are aware “they are missing things in life,” but are too busy to do something about it. Makhija confirms that his products are meant for occasional anxiety that arises before a meeting, a deadline, or when faced with too much work. As per the box, they contain “5 clinically proven ingredients” – L-theanine, holy basil, sage extracts, chamomile extracts, and passion flower. “We are also of the view that these things should be managed in a long term way,” he adds

Another product, which looks like a common mouth spray (offering “pocket-sized tranquility,” as the description says), claims to work in 10 minutes. Over the phone, the founder of AndYou, the company behind the product, relies on words like “realign” and “feel in control” to endorse his products and their star ingredient – cannabidiol, more commonly known as CBD. AndYou’s products have been specifically designed keeping a “high-intensity working professional” in mind, the founder says, wishing not to be named.

The popularity of such products is also fuelled by the fact that despite all the awareness around mental health, there are few meaningful solutions on offer. The National Mental Health Survey (NMHS), 2016, found that India has only 0.75 psychiatrists for 100,000 people. The budgetary allocation for mental health in the annual budget has remained stagnant for several years, hovering around 1% of the total allocation. This year, it received 1,100 crores, nearly 80% of which went to a single institution: NIMHANS. “Majority of funding goes to institutions. There is very little investment in community-level interventions,” explains Preetha Krishnadas, Assistant Director at The Banyan.

Instead, the private mental health sector is growing, offering technocratic solutions. There’s Wysa, an AI app that offers CBT, which raised $20 million in series-B funding in 2022 (it claims to have “helped” five million people and “covered” 11 million “lives”). Lissun, a mental health platform, raised $1.3 million in seed funding. Being, another mental health app, raised $1.4 million over two rounds of seed funding and is in the midst of closing another $3 million seed round. JumpingMind.ai, raised close to $500,000. Mave Health, raised 6 crores; this is a company aiming to design a wearable, non-invasive brain stimulation device to treat depression. All are for-profit companies. In the start-up world, these are average sums of money – calling into question the companies’ longevity. Which in turn calls into question their ability to cater to the longstanding mental health needs they set out to address over a sustained period of time.

Mental health has thus been reduced to yet another capitalist trend, raising the question of whether the growing burden of anxiety is worsened by the ubiquity of profit-seeking solutions. Even seemingly benign pop-interventions for anxiety relief have their own risks. Take mindfulness, an industry that boomed over the last few years, promising to alleviate stress and anxiety, with multi-million dollar apps adopting names like Calm and Headspace. One meta analysis found that meditation and mindfulness actually led to anxiety and other adverse effects in some people. Another UK mindfulness programme for improving mental health in young people actually had the opposite effect: it increased anxiety, in no less than 8,000 participants.

Kalha says what happened to the mental health sector is in line with what the development sector sees from time to time: certain major issues becoming a “thing.” Gender was one, at one point. “Everybody was doing gender, even if they were not following feminist principles in life,” she says. Now, it’s mental health. “When people are in the business of mental health – and I'm using the term business very consciously – they’re also focused on selling the idea of recovery,” says Babre. “We’re talking about a global market which is almost 400 billion dollars.”

None of their work even reduces the mental health care gap significantly, Kalha says. Because a lot of the time, they approach it like the health system always has, which is to create more psychiatrists, more psychologists, more hospitals. “In general there’s health-system biased thinking which is to put more professionals instead of creating better policies.” All these “solutions” ignore the ground realities of addressing mental health, such as evidence showing that cash transfers and providing housing are significantly more helpful in the reduction of suicide deaths. “The policies and solutions for mental health are sometimes not in the health space, they’re everywhere else,” Kalha adds.

For so much press and resources poured into it, being open about anxiety is not actually as mainstream in India as it seems. “This perception of mainstreaming often pertains to a specific demographic: primarily an educated, English-speaking, and digitally connected segment of society,” notes Paras Sharma, founder of The Alternative Story. The confluence of corporate interests and celebrity culture have led to a group – let’s call them the professional managerial class (PMCs) – of people coming to be overrepresented in the mental health discourse. “That’s not what we’re seeing in rural communities – you can’t tell your employer that you need a mental health day,” says Kalha.

The average cost of therapy in an Indian metro city is INR 1,500, amounting to INR 6,000 per month for weekly sessions, according to the Alternate Story. Only the top 10% of people in India earn above INR 25,000 per month. The uptick in conversations and awareness about “seeking help” for anxiety, then, doesn’t necessarily correlate to healthier outcomes on a large scale. Increasingly, it just seems like we’re in a loop – of discourse, diagnoses, and denial.

All this to ask: if we’re more aware of anxiety now, and we have a name and several diagnoses to describe it, to what end? Most experts agree: it’s not feasible, or even desirable, to rid ourselves of anxiety completely, or avoid it.

And yet, with the “ascendance of a ‘global monoculture of happiness’ premised on psycho-pharmaceuticals, consumerism and cultures of aspiration,” as Bhrigupati Singh puts it, it’s easier than ever to pathologize discontent as anxiety or depression disorders. There's a global incentive system to force an exhausted – and languishing – population to overly scrutinize and subsequently cure a survival mechanism in order to get closer to the promise of well-being.

But privatized, corporatized, or Instagramized mental health won’t fix the anxiety crisis. Neither will public healthcare, if it remains confined to the biomedical model. It’ll have to be something else – in-between, but also outside. “We need to customize interventions according to different socio-economic, cultural groups,” says Dr. Ramesh K.S. – because everyone, irrespective of their diagnosis or social location, is suffering to varying degrees. “There's a vast proportion of individuals experiencing subsyndromal stress and worry, which doesn't meet the criteria for a clinical diagnosis but still significantly impacts well-being,” Sharma says.

Take the interventions that have been shown to alleviate anxiety: birdsong, greenery, reducing social media usage, sleep. But our cities are killing green spaces and birds, technocapitalism is feeding off our anxiety on social media, and there’s a huge sleep crisis thanks to overstimulation and stress. It tells us that the problem isn’t the anxiety – the problem is everything else.

A lot of the existing mental health interventions, focused as they are on recovery, emphasize a return to productivity and well-being as the end-goal. We, who are perpetually exhausted, crave this while simultaneously being aware, deep down, that a return to business as usual is perhaps not what we really want. It’s a bit like the American Dream – we chase what we know doesn’t really exist and isn’t really attainable. And we do so through pharmaceuticals, meditation apps, and talk therapy. The affect theorist Lauren Berlant called this “cruel optimism,” which they defined as “when something you desire is actually an obstacle to your own flourishing.”

The process of recognizing and coming to terms with what may underlie the anxiety is undoubtedly a longer, more difficult one than a quick fix. Or even a “fix” at all. Instead, Vidha prefers the term “discernment.” To discern what the anxiety is about, how much of it requires change and how much of it requires grieving and acceptance.

There is no way to tell how we ended up here, and there is no clear way out – unless we retrace our steps and question the baseline assumptions around anxiety. In other words: in a world ravaged by imminent climate disasters, televised wars, political instability and economic precarity, is it anxiety that’s abnormal, or is it the conditions of life?

*Names changed to protect anonymity.

Additional reporting by Ananya Singh.