Medicalising

The most common representation we found was one which viewed anxiety through a medicalising lens. Reference ConradConrad (2007) describes medicalisation as the process of taking what have been previously seen as non-medical problems and converting them into illnesses and disorders. Reference Good and GoodGood (1994) has noted how adherence to faith-based religion began to give way to evidence-based science, which was underway in Europe during the Reformation period of the sixteenth century and became increasingly dominant during the Enlightenment period of the seventeenth and eighteenth centuries. Reference BourkeBourke (2005) points out that in earlier times, priests would have been more commonly consulted for anxiety, whereas in contemporary times, it is family doctors who are sought. Reference LittlewoodLittlewood (2002, p. 1) has suggested that in Western countries, distress has been medicalised, seen as coming from outside with a cause, pattern and possible cure. Medicalisation can be viewed as related to power; for example, Reference ShowalterShowalter (1987) has discussed how women who wanted to divorce their husbands or campaign for the vote were sometimes diagnosed with ‘hysteria’ which classed them as in need of medical control. The medical model is perhaps the most frequently used way of representing anxiety in the forum, indicating how it is widely accepted as a ‘common-sense’ or taken-for-granted way of understanding the concept.

A key example of the medicalisation of anxiety is in the form of the word itself. Anxiety is a singular common noun (the plural form anxieties is much less common in the forum, occurring only 843 times). However, there is a related adjectival form, anxious, which occurs 18,217 times, being eight times less frequent that anxiety. To describe oneself as anxious is to imply a non-medicalised state, similar to possessing a (usually non-constant) trait such as being happy, afraid, grateful, proud and delighted – words which strongly collocate with I am in the English Web 2020 corpus. Anxious is therefore akin to a feeling, while anxiety is more suggestive of a long-term state.

Table 2.2 shows the different patterns around anxiety which were suggestive of a medicalising representation.

By, far, the most common linguistic indication of the medicalising representation of anxiety in the forum is through the phrase have anxiety, which occurred 10,309 times. Have usually precedes a past tense verb (e.g., I have walked) but it can also precede a noun phrase to denote possession or a state of being (e.g., I have mixed feelings). In the English Web 2020 corpus have precedes medical conditions such as diabetes, AIDS, flu and toothache, which thus positions anxiety in a similar way.

• When you have anxiety my doctor told me your senses heighten.

One phrasing involves the preposition with; for example, being diagnosed with anxiety or describing someone as a person or patient with anxiety. The language surrounding the latter cases echoes wordings that have been used to describe other conditions in a responsive way. For example, Reference Dilmitis, Edwards, Hull, Margolese, Mason, Namiba, Nyambe, Paxton, Petretti, Ross, Welbourn and ZakowicsDilmitis et al. (2012) have argued that language should put people first rather than an illness or condition. They argue that ‘people living with HIV’ should be used as opposed to ‘infected people’, which puts the virus first. Similarly, Reference LynnLynn (2017) argues that language such as AIDS patients or HIV positive women stigmatises and dehumanises people, reducing them to a diagnosis. This people-first use of language also occurs in the Anxiety Support forum.

• People with anxiety should not be treated differently.

However, in the forum there are more cases where people-first language is not used; for example, anxiety sufferer, anxiety patient. The following excerpt is an interesting example of medicalisation as the poster claims that anxiety is not understood by the medical community, thus implying that there is not enough medicalisation of anxiety.

• The problem is we have became doctors by choice because the medical community can’t come to grip’s with what we as anxiety patients go through until it happens to them??

Anxiety is also frequently followed by words which characterise it as a medical phenomenon. One collocate that might have been expected to occur is clinical, which we found as a collocate of depression in the forum (70 cases), however, the phrase clinical anxiety never occurred in the forum. Instead, the most common medicalising phrase was anxiety disorder (2,913 cases) with less frequent references to anxiety diagnosis (28), anxiety relapse (13), anxiety condition (56), anxiety episode (94) and anxiety bout (15). Anxiety disorder is the most frequent due to its appearance in two named anxiety-related disorders which appear in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5): generalised anxiety disorder and social anxiety disorder.

• Hello all I’m new to this group and I was just recently diagnosed with generalized anxiety disorder and depression.

People in the forum also label anxiety as a medical condition; for example, using the phrasing anxiety is a/an … illness (63), condition (32), disorder (25) or disease (11).

• Anxiety is a true disorder and shouldn’t be dismissed.

• You must learn to live with a chronic and debilitating disease just as one does with MS or Hepatitis or AIDS because anxiety is a chronic debilitating disease.

There are smaller numbers of cases where people argue the opposite; for example, in seven cases people argue that anxiety is not a disease.

• Anxiety is not a disease, may be an illness at best (nervous illness) but not a disease.

• Anxiety is not a disease but rather a sympton(s).

• Anxiety is not a disease. It’s a disorder inflicted, unwittingly, by the sufferer themselves.

However, these cases which reject the representation of anxiety as a disease still refer to a medicalising discourse in that they instead view anxiety as an illness, symptom or disorder. Similarly, people who argue that anxiety is not an illness, often simply use a different medicalising term rather than rejecting the medicalising discourse.

• Anxiety is NOT a mental illness, it is a physical disease.

• One thing keep in your mind that Anxiety is not an illness, it is a condition.

If anxiety is viewed as some sort of medical condition, then an accompanying set of representations view it as something that can be diagnosed, treated, managed or even cured or healed. Posters tend to use treat and manage to advocate medication or therapy as options.

• Propanolol is a very good medication for treating anxiety.

• Many manage anxiety without drugs, it depends on which way is suitable for each person.

However, cure tends to be used in a more complex way; about half of the time posters believe they can be cured or claimed to have been cured, while the other half argue that a cure is not possible.

• As I said earlier, acceptance of the symptoms you dislike (fear) so much will cure anxiety.

• Unfortunately propranolol can’t cure anxiety, its merely a tool to help the body reach a state of calm.

Heal is used less frequently than cure and treat and tends to be associated with less well-established treatments.

• I stumbled on a book that I purchased the other day called ‘Play it away’ by Charlie Hoehn it’s a book on a young man who had really bad anxiety and overcame it by having fun every single day! He healed his own anxiety and depression in weeks!!

Patterns involving noun phrases also indicate the medicalising view that anxiety can be treated in various ways; for example, through pharmacological intervention (anxiety medication), therapy (anxiety therapist) or other forms of support (anxiety website, anxiety class).

Normalising

While the medicalising representation of anxiety is dominant in the forum, there are other ways of framing anxiety that are non-medicalising, one of which we refer to as normalising. On very rare occasions, posters explicitly reject medicalisation.

• I love the way they have invented modern medical terms like social anxiety for terms like shyness. Another one is health anxiety instead of hypochondria.

The Word Sketch analysis found that normalisation tended to occur in ways which involve representations around what anxiety is or is not (Table 2.3).

This can involve the use of a somewhat informal, colloquial language, where anxiety is (usually) characterised negatively as problematic, but it is labelled in a vague or even dismissive way; for example, a thing, stuff, crap or shit as opposed to being a syndrome, disorder or illness.

• I have suffered all my life with insomnia even before this anxiety thing.

• It sure doesn’t take long to get sick of this anxiety crap.

Normalisation also occurs with explicit rejection of terms such as disease or illness, whereby anxiety is instead characterised as a state of mind or learned behaviour.

• Anxiety is not disease! It is just state of mind!!

• And remember, anxiety is not an illness, it is learned behaviour, and bad thought processes that you have trained yourself over the years.

Anxiety is also described as part of the human makeup, part of life, or part of everyone, as the following post, where anxiety is represented as an aspect of all humanity.

• I am accepting that anxiety is part of every single person in this world, it’s part of our make up, part of who we are. If we didn’t have anxiety and worry about certain things we would not be human.

Terms such as normal anxiety may appear to be part of the normalising representation but they are used in a slightly more complicated way, with posters making a distinction between normal anxiety and the anxiety that they experience, which they view as not normal, and thus cause for concern.

• I turn away from anyone who puts the word “just” in front of anxiety. It’s like minimizing it. There’s the normal anxiety that many people feel and then there is chronic ANXIETY they we live with everyday. They are not alike.

Instead, the phrase anxiety is (a) normal, tends to be more typical of normalisation.

• Anxiety is normal amongst adults, cos there are many pressures to deal with..….

• When you understand that anxiety is a normal human response to a perceived threat that usually isn’t real, it loses it’s power. It is maladaptive behavior that you have developed, for what ever reason, to stressful events.

At times, medicalisation and normalisation can appear to be intertwined. In the following example, a poster describes a treatment plan for anxiety, which suggests a medicalisation model, although the plan advocates normalisation of anxiety.

• (These details are from Treatment Plans and Interventions for Depression and Anxiety Disorders by X L. X and X X Holland.) There are a few steps you can take that may be helpful and here are some coping statements that might be useful. 1 – Normalize your anxiety: Anxiety is normal. Everyone has anxiety. Anxiety shows that I am alert. Anxiety may be biologically programmed (this may be the “right response at the wrong time”- there is no danger that I have to escape from).

The representation of anxiety as normal is therefore sometimes used strategically, as part of therapeutic programmes that reframe anxiety as a form of biological programming that has gone awry.

Catastrophising

The second pair of representations around anxiety on the forum are related to its extent and effect on the person experiencing it.

Table 2.4 indicates that many posters describe their anxiety using superlative language (severe, major, extreme, intense, acute, massive, biggest, super, excess), emphasising that their problem is serious. Some posters explain that their reason for joining the forum is due to an intensification of their anxiety.

• Just joined today as have been having severe anxiety for 3 weeks but suffering from it since i was 14

The experience of anxiety is also described as constant (chronic, daily, ongoing, everyday, constant, long-term, prolonged).

• I am going through constant anxiety, feeling sick every day to the point where I feel like I am going to throw up but I never do

• Never able to get back to sleep, then spend 2 hrs in a constant state of extreme anxiety

Terms such as constant and perpetual represent anxiety starkly, as never-ending, whereas in the preceding second excerpt, the poster notes how they are never able to get back to sleep.

Anxiety is also described in strongly negative terms (bad, terrible, horrible, awful, crippling, debilitating, horrendous, horrid, dreadful, horrific, nasty). Posters describe how they are unable to leave their home or bed due to crippling anxiety, which suggests that the term is not always used metaphorically.

One aspect of this representation which is metaphorical though is the use of descriptors such as high, heightened, sky-high, gone up and through the roof which position worsening anxiety as ascending.

• The problem is now my anxiety is sky high and I am struggling to cope.

This metaphor can be contrasted with Reference McMullen, Conway and FussellMcMullen and Conway’s (2002) categorisation of representations of depression, which involve darkness (‘like a black cloud’), weight (‘weighing me down’), captor (‘I feel trapped’) and descent (‘I feel down’). Similarly, Reference Charteris-BlackCharteris-Black (2012) has also noted that depression can be characterised in terms of containment and restraint (‘in a pit’, ‘pour out’), while Reference SeminoSemino (2008) reports that the metaphorical domains most used by people talking about depression were ‘up/down’, ‘enclosed space’, ‘journey’ and depression as a ‘physical entity’. Across these studies, the metaphorical framing of depression as descent is typically the most common. Thus, anxiety is a metaphorical opposite of depression, in that the worse it is, the more likely it will be represented as moving upwards.

Another way of representing anxiety as extremely bad is by using the term anxiety attack. Attack is a nominalisation of the verb process to attack, which indicates that anxiety is represented as attacking the person who experiences anxiety. Other types of attack in the corpus include panic attack (15,879 occurrences), heart attack (3,896) and asthma attack (72). Within the English Web 2020, heart and panic attacks are also relatively frequent, although other forms of attacks imply an external attack, carried out by others; for example, terrorist, cyber, bomb, rocket, air, enemy, nuclear, drone, phishing, ransomware, chemical. The prosody of attack therefore implies that anxiety is akin to a separate force, attacking an individual.

• just came off a 10hour flight a few hours ago, had an anxiety attack on and off the whole journey causing back and chest pains, feel extremely light headed almost as im unreal

The term is used uncritically, although one poster questions the usefulness of the term panic attack.

• I think the term panic attack is not very accurate either. The very mention of the word can also send some people into a tailspin when in a sensitised state. I prefer to call them energy surges because that is all that is happening.

Posters also describe hating anxiety or write that they wouldn’t wish it on anyone else, as a way of emphasising how terrible their experience is.

• I can’t deal with this no more feeling like I can’t breathe I hate this anxiety it’s ruined my life!!!!!!!

• Nobody in their right minds would want this. I dont wish this evil anxiety on my worst enemy!! But if people could just feel what this is like for 1 hour or feel just one panic attack they would never doubt us ever again.

The word form suffer occurs in various constructions; for example, suffer from anxiety, suffer/struggle with anxiety, suffer anxiety, and additional posters describe themselves and others as anxiety sufferers.

• Hey guys I been suffering from anxiety for ever it has taken things I love in my life things I can’t do now at 43

Compared to other ways of describing anxiety (I have anxiety, I have been experiencing anxiety, I feel anxious), the verbs suffer and struggle place emphasis more firmly on negative aspects. Of the words we examined related to anxiety (see Table 2.1), only illness tends to also occur with verb forms of suffer. In contrast, the terms anger, confusion, frustration and grief, indicating feelings and emotion, were not ‘suffered’ and, thereby, did not carry the same associations of illness, suggesting that suffer also indicates a medicalising representation as well as a catastrophising one.

Finally, anxiety is also characterised as carrying out actions which aim to hurt or diminish the person who has anxiety: ruin, strike, cripple, drain. These constructions are discussed in more detail in the following sections, which consider the anthropomorphising representation of anxiety.

Catastrophising stems from a perception that a situation is worse than it is or will result in much worse consequences. Reference Chan, Chan and KwokChan et al. (2015) found that catastrophising was a positive predictor of anxiety among adolescents. Some representations of anxiety may not be viewed necessarily as helpful in terms of decreasing symptoms, while others may be helpful for some people but not others. However, there seems to be more general acceptance among health practitioners that catastrophising exacerbates anxiety, resulting in increased suffering. It is important to emphasise that the kinds of language use described here are not cases of people with anxiety exaggerating or lying about how they feel – one characteristic of catastrophising is a lack of awareness that it is happening. It is also not the case that every case of language use associated with Table 2.4 should be seen as unhelpful. For example, a claim such as ‘My anxiety has become worse over the last six months’ is useful in terms of understanding someone’s history of anxiety. However, the potential negative effect of representing anxiety as negative and through the use of the more hyperbolic uses of language in Table 2.4 is worth taking into consideration.

Minimising

In contrast, another representation of anxiety attempts to minimise its effects (Table 2.5).

This can be done through adjectives which characterise the amount as low, slight or moderate. Posters describe having a bit of anxiety, a little anxiety, or less anxiety than that which they had previously experienced. These kinds of representations are often used by posters who are responding to other people’s posts, as a form of support.

• Hi Im so glad you having a good time and finding things to ignore those little anxiety niggles

Rather than focusing on the amount of anxiety, some posters attempt to minimise its importance, referring to it as just anxiety or only anxiety.

• But I have been copeing better just realise its just anxiety

• When they come try to label them as “just anxiety” and do deep breathing exercises

Another set of descriptors classify anxiety as something that is recognisable (classic, common, typical) and thus manageable, as opposed to something unknown and untreatable.

• Again, this is classic anxiety – misleading and fooling us into thinking we have serious illness

• You’re in the right place, it sounds like you’re having typical anxiety

The following post is an excerpt from a response to another poster who has asked the forum about whether their experience of their heart racing should be checked out. The poster responds in a somewhat chiding way, positioning their initial poster’s experience as ‘just the same old anxiety’. By characterising it as something familiar, the poster attempts to minimise its effect.

• It’s not fair to sound the alarm with other people and to post questions about your heart when it’s just the same old anxiety that you choose to do nothing about. You need to remain silent every time your heart acts up like it has, no posting for help, no describing it and making people think you’re having a heart attack, nothing.

Another way of minimising anxiety is to refer to it as irrational and therefore not needing to be taken seriously (e.g., stupid or crazy).

• Remember it’s just stupid anxiety and it will not harm us

• I also have an anxiety med I only take about 3–4 times a year when crazy anxiety raises it’s ugly head – to nip it in the bud and remind myself I am in charge.

A less frequent representation in this category is to characterise anxiety as something that is not negative.

• Do not think about your anxiety do not think about your issues instead embrace them. I have come to face the fact that anxiety is not a bad thing at all.

Other forms of this representation involve noting how it attempts to trick people into taking it seriously or characterising it as a paper tiger, a term which is a literal translation of the Chinese phrase zhilaohu. Mao Zedong, Chairman of the Chinese Communist Party, regularly used the phrase to dismiss American imperialism in the 1940s and 1950s.

• Hi lovely, what you are feeling is adrenaline and anxiety tricking you into thinking these things.

• However we have to be brave and expose anxiety for the paper tiger that it is by trying not to be afraid of our symptoms.

Additionally, rather than characterising one’s experience of anxiety as involving suffering, there is focus on dealing with, overcoming, accepting, reducing, coping with, living with, recovering from or managing anxiety. There are important differences here – recovery suggests a complete cessation of symptoms while management indicates that anxiety is not cured or resolved but that it can be controlled. However, all of these verbs are indicative of a mindset which focuses on the possibility that the situation can be improved.

• I believe that once you recover from anxiety the symptoms such as exaggerated fear of death will pass.

• After my fear of tablets I went to CBT a therapy and although found it very hard work, I can finally say that learning to manage my anxiety when it flares up I’m now positive about my future

Not all cases of minimisation are evaluated as successful. Some posters write about how their attempts at minimising anxiety can conflict with other thoughts.

• it really does freak me out keep telling myself its only anxiety but then when it comes i think how can anxiety possibly feel like this its as if your world is falling in around you i hate it so much and just want to go back to being myself again

However, what is most notable about the catastrophising and minimising representations is how they are split between posts that are advice-seeking and those that are advice-giving, respectively, suggesting that the former representation is more associated with those who are struggling with anxiety while the latter representation tends to be from people who believe they can offer insights and help, based on either their own experiences or through information-gathering.

Anthropomorphising

In this representation, anxiety is cast as a living being, often a human, but sometimes an animal or a supernatural entity (Table 2.6). What these more specific representations have in common, though, is that anxiety is afforded agency of its own, so it is frequently described as carrying out actions or having goals.

This kind of representation appears to be more specific to anxiety than depression, although we did find cases where fear was anthropomorphised with posters writing about how fear was their worst, real, true or arch enemy.

We have included titles like Mr in this category, as they were used in order to personify anxiety as a familiar entity.

• I bet tomorrow is not as bad as you think ~just Mr Anxiety playing nasty tricks on you and making you fear the worst ~been there done that and got the t shirt lol

In these kinds of personifications, anxiety is almost always represented as male – across the whole corpus there is only one mention of Mrs Anxiety and one of Miss Anxiety, which the poster characterises as being a partner in an abusive relationship.

• Miss Anxiety is my narcissistic life partner who is always fighting with me, bullying me and torturing me, but at the same time she loves me so much that she never leaves me alone.

Similarly, Mr Anxiety is described as a ‘lifelong companion’.

• Mr Anxiety does NOT have to be your lifelong companion – you can give him the heave-ho.

Another way that anxiety is anthropomorphised is by referring to it as a fantasy entity (beast, devil, monster, demon), a malign human (bitch, culprit, enemy, liar, bully, trickster, fraud), or, less commonly, a vicious animal (tiger), although as described earlier, the tiger is always described as a toothless tiger or a paper tiger, with posters characterising it as only appearing vicious.

• Anxiety is a beast that takes no prisoners, just when we feel we are doing well it sneaks up on us and bang were back at square one.

• anxiety is a liar, it whispers in our ear and makes us believe we have all sorts of serious illnesses when we have nothing of the kind.

Similar to the minimising representations, many of these kinds of anthropomorphising representations occur in advice-giving posts.

• The more we struggle, the more the anxiety bully fights us back sometimes with different symptoms in order to alarm us.

An important aspect of the anthropomorphising representation is that anxiety is shown to be carrying out actions or causing things to happen.

• Anxiety causes our system to go into over drive

Anxiety is also described as having conscious thoughts and desires, deciding, wanting and loving things. Although love appears to be a positive word, it is used to describe anxiety as desiring negative outcomes for the person experiencing it.

• My anxiety loves to find new ways to scare me.

• Anxiety never wants us to get too comfortable with ourselves and so it waits for the right opportunity and hits us with another reminder that it is in control.

Similarly, verbs such as give, work and create characterise anxiety as causing unwanted symptoms.

• Do you think it might be the anxiety giving you these thoughts

• no answers but a local physio told me it was my anxiety working over time

• my anxiety creates a fever like temperature in my head which make’s me truly think something wrong happened upstairs

A related set of verbs involve representations of anxiety as a manipulative entity which mentally abuses people.

• There’s absolutely no reason to believe you have cancer X, that’s your anxiety talking, don’t listen to it.

• What I’ve noticed though, is if I do accept that it’s anxiety messing with me I have a really good day!

In this category anxiety is described as playing tricks, scaring and exaggerating. It is also described as waiting for its chance to cause trouble.

• as soon as you stop taking the meds the anxiety is still there waiting to play games with your head.

Additionally, anxiety is assigned as the experiencer of the negative thought processes as opposed to the person who experiences anxiety.

• That is your anxiety thinking negative thoughts.

A less common set of verbs involves descriptions of anxiety as beating the poster. These verbs often occur with negation where posters exhort one another or themselves not to let anxiety beat them.

• Anxiety well never win unless you let it.

• sometimes it’s hard, but I’m not going to let this monster called anxiety beat me.

Other verbs in this representation describe anxiety as moving (creep, follow).

• I would say it’s your health anxiety following you to the gym.

• Been fine all day come tea time felt anxiety creeping up on me.

Finally, we have included a set of verbs which position anxiety as the patient of an action. Posters talk about challenging, combatting, battling and beating anxiety. These kinds of verbs could be seen as a subset of minimising representation verbs, although we note how they are different from instances where posters talk about curing or managing anxiety. Instead, they cast resolution of anxiety in terms of beating an opponent. In the following excerpt, the poster acknowledges the metaphorical nature of the representation by putting the word weapons in quote marks.

• As you know, there is no secret recipe for dealing with loss and tragedy, but providing yourself with an assortment of “weapons” to combat the anxiety is your best bet to defeat it!!

Viewing anxiety as a living being can be seen as a management strategy for some posters. Reference Chen, Chen and YangChen et al. (2019) have described a study where individuals who were instructed to anthropomorphise sadness or happiness reported less experience of that emotion afterwards. They argue that the reduction of emotion occurs because anthropomorphic thinking increases the perceived distance between the self and the emotion, which results in a sense of detachment.

Abstracting

On the other hand, anxiety can be viewed in a variety of ways that constitute it as an abstract state or entity (e.g., something which has no concrete state).

We have already encountered some of the words in Table 2.7 before. For example, calling anxiety a disorder is also a form of medicalisation, while describing it as a nightmare is a form of catastrophisation. However, other words in the table suggest different perspectives. For example, some posters represent anxiety as an experience, journey or story, which frames it as part of a person’s life narrative.

• the anxiety journey is sometimes 1 step forward 2 steps back.

• We became friends up here and shared our anxiety experiences and now friends in the real world.

• I’m hoping I may get a little comfort or relief by pouring out my, probably, uninteresting anxiety story

A less frequent category of words describe anxiety in terms of a negative and repetitive experience, using terms such as cycle, loop and spiral, a set of characterisations which are linked to acknowledging that the catastrophising representation can result in increased anxiety.

• so i dont know wether you notice …. that there is a pattern here …. the anxiety cycle. one fear leading to another and another.. …. you have the TRIGGER––≫FEAR–––-≫STRESS––––≫WORRY–––≫ANXIETY–––-≫PANIC ATTACK–––≫TRIGGER. on going cycle of anxiety disorder.

Anxiety trap works in a similar way.

• try focusing your attention on other things that can help you overcome the anxiety trap

In this category we have also included words which involve increasing anxiety such as heighten, worsen, raise, escalate, add, exacerbate and spike. Again, these verbs are often used in explanatory contexts.

• The more we focus on our bodily functions it can heighten your anxiety and make you feel worse.

Escalate is used in the English Web 2020 corpus to refer to abstract phenomena such as tension, violence, conflict, war, crisis, confrontation, and dispute.

• The anxiety just escalates it by a million percent.

Subside also has a semantic prosody for abstract entities. In the English Web 2020 corpus, things that subside include laughter, pain, swelling, anger, fever, storms, floods and fighting.

• I know when my anxiety subsides the symptoms will too.

Additionally, anxiety is represented as abstract negative phenomena; for example, as a repetitive process (circle, cycle), a place (hell), a bad dream (nightmare) or a contest (battle, game).

• I know that anxiety is hell because I suffer from it too.

• I just want to tell you that anxiety is a vicious circle that keeps you feeling bad as long as you feed it.

• Anxiety is a game, it plays tricks on you, once you understand the gist of it, expose yourself, accept it

Coming somewhere between the abstracting and anthropomorphising representations of anxiety is a much smaller third set, which frames anxiety as a non-living object. For example, there are verb metaphors such as fix and fuel which cast anxiety as something akin to a machine.

• The fact that the medical profession only masks symptoms and has no conclusive understanding of the brain, basically means that you are paying for someone who has about as much chance as fixing anxiety as a plumber!!

• I keep googling symptoms too which is fuelling my anxiety.

Other verbs also imply non-living agents that are typically associated with natural, human-made or abstract phenomena, as magnify indicates.

• Anxiety magnifies all our fears tenfold

In the English Web 2020 corpus, things that magnify are objects created by humans: eyepieces, microscopes, glasses, mirrors and telescopes.

Finally, there are another set of verbs, often denoting physical violence, which characterise anxiety even more negatively as an entity which physically abuses the sufferer. It is difficult to categorise these verbs as referring to an abstract, living or non-living entity as they tend to occur in general language use in a wide range of contexts. Some of these verbs are used in metaphorical ways to describe anxiety as appearing or worsening (e.g., kick in, flare, strike). These verbs can index natural phenomena, for example, in the English Web 2020 corpus, strike tends to be associated with lightning or earthquakes although there are also references to human-made objects (bullet, missile, car) or abstract concepts (tragedy, disaster) striking.

• sometimes anxiety strikes out of the blue for no reason

• it’s not long before anxiety soon kicks in and wrecks everything again!

The abstract representations of anxiety can involve both metaphorical and non-metaphorical cases and can encompass medicalising and catastrophising representations as well as also being those used in supportive or explanatory posts aimed at helping others to understand or cope with anxiety. This representation thus appears to be the most versatile and varied in terms of both its forms and its functions.

Owning

We now move to the final two representations, which consider the question ‘Is anxiety part of the person experiencing it or is it a separate entity?’ A common way of doing this is to refer to having anxiety, which we have also classed as a medicalising representation. However, a related phrase involves the choice not to use the word anxiety but to instead use the adjectival form signified through phrases such as anxious person.

• I am a very anxious person, I do tend to think the worst and worry about my health when something doesn’t feel right.

Additionally, when people used terms such as anxiety brain or anxiety mind, they are labelling part of themselves as possessing or having the quality of anxiety.

• Anxiety brain feels weird, like its vibrating and wants to shut down.

There are also phrases which feature a noun followed by with anxiety (e.g., person with anxiety), which have been seen earlier as part of the medicalising representation. The phrase have anxiety also implies that anxiety is part of oneself.

However, the most typical way of signifying that anxiety is part of oneself is through use of possessive personal pronouns, of which my is by far the most frequent (Table 2.8).

• I had a flair up over christmas and new year with my anxiety and the awful symptoms

First-person pronoun use has been associated with other mental health conditions, most notably, depression. Reference Zimmermann, Brockmeyer, Hunn, Schauenburg and WolfZimmermann et al. (2017) carried out a longitudinal study of 29 patients with clinical depression, reporting that they did not find a significant association between depressive symptoms and first-person pronoun use. However, first-person pronoun use did predict depressive symptoms approximately eight months later and this was largely due to use of two types of pronouns: objective pronouns (me) and possessive (my). Reference Tackman, Sbarra, Carey, Donnellan, Horn, Holtzman, Edwards, Pennebaker and MehlTackman et al. (2019) found that while there was a small but reliable correlation between depression and first-person singular pronouns, this did not include possessive pronouns. These studies do not necessarily focus on the phrase my depression though, but instead consider all uses of my, which suggests depressed people may use more self-centred language overall. With a phrase such as my anxiety, the emphasis is on characterising the mental health condition as belonging to the person experiencing it. Reference HuntHunt (2013) examined a corpus of posts from the forum depressonline.net, finding that when people use my depression they are more likely to discuss its impact upon their personal relationships, whereas when they use the depression, they focus more on the effects that depression has on them personally. He also found that posters who used the term my depression were more likely to claim to be experiencing relief from mental illness and hypothesises that this might be because these people are coming to terms with their condition.

The top 20 collocates of my anxiety in the corpus are worse, has, bad, depression, started, is, high, makes, through, because, levels, made, when, with, control, making, attacks, due, caused and panic. The collocates indicate a focus on the extent of someone’s anxiety (e.g., levels), how it causes or co-occurs with other mental health conditions (panic, attacks, depression) and how bad it is (worse, bad, high, through – which normally occurs in metaphorical phrases such as my anxiety is through the roof). There are also collocates which indicate efforts to understand what causes anxiety and how anxiety causes other conditions (makes, made, control, due, caused). Illustrative examples are shown in the following:

• We had dreadful noisy neighbours and my anxiety was through the roof every weekend and bank holiday due to loud music, drinking and shouting

• My anxiety and panic attacks have become a lot worse and I’m starting to get to the point where I can’t cope with it any longer.

There appears to be some overlap then between characterising anxiety as part of oneself while describing particularly bad experiences.

Distancing

Finally, there is a representation of anxiety as being separate from the person experiencing it. The anthropomorphising examples listed in earlier parts of this chapter could be seen as a subset of this representation (e.g., anxiety monster), and to avoid repetition we focus here on cases which involve use of a determiner (Table 2.9).

The most frequent form of distancing representation in Table 2.9 involves the word the.

• I really do find that the anxiety is now more under control

However, a related (but less frequent) modifier is this.

• i had an accident and broke two vertabre in my back my back is now manageable with physio but this anxiety has floored me

The top 20 collocates of the anxiety are causing, forum, welcome, depression, worse, cycle, part, makes, control, symptoms, attacks, comes, away, keeps, causes, itself, panic, because, let and caused. Eight of these collocates overlap with the top ones for my anxiety (worse, depression, makes, control, because, attacks, caused, panic). Two of the others (welcome, forum) are the result of responses to posts where members refer to the Anxiety Support forum, so do not really indicate cases where people refer to having anxiety.

• Welcome to the Anxiety Forum. You have come to the right place to get support and understanding of what you are going through.

The collocate comes describes the onset or return of the anxiety and there is also focus on whether the anxiety will go away. The following two examples therefore represent anxiety as an unwelcome visitor, as opposed to something which is an integral part of someone’s identity.

• You can’t avoid the anxiety once it comes in so why fight it.

• Is that really too much to ask for the anxiety to go away so I can relax and sleep.

While the anxiety does have one collocate that indicates the severity of anxiety (worse), on the whole there are fewer of these kinds of collocates, compared with those for my anxiety. We should also note that references to my anxiety tend to be more common in initial posts (1,492.45 per million words), which can often involve cases where people are describing problems or requesting help as opposed to uses of my anxiety in responses to posts (702.76 per million words) which more likely involve posters providing support. As shown in Table 2.10, the phrases the anxiety and your anxiety are more likely to be found in the responses to posts.

Uses of the anxiety with collocates such as cycle, causing, causes and part tend to involve explanations or reassurances, which are more typical of responses to posts, rather than initial posts.

• I’ve been told to try floating through the anxiety and just accecpting it. I guess that’s how you break the anxiety cycle.

• The fear of going insane is all part of the anxiety illness and I would suggest we have all had it.

• It might be an idea to have a talk with your doctor so that you can feel reassured that it is the anxiety causing your symptoms.

Reference Hunt, Harvey, Baker and McEneryHunt and Harvey (2015) note that on a forum relating to eating disorders, uses of possessive phrases such as my ED are much less common than phrases such as the ED, indicating that posters usually discuss eating disorders as a condition which is distinct from the individual. However, this does not seem to be the case with discussions around anxiety, where my anxiety is more frequent than the/this anxiety.

In terms of framing, as with anthropomorphism, viewing anxiety as something separate from the person experiencing it may increase a sense of detachment between the self and the feeling, which could be helpful in terms of decreasing perceptions of anxiety’s effects. We note how the people who used my anxiety were more likely to refer to its worsening levels, suggesting that, to an extent, catastrophisation was occurring when people characterised anxiety as part of themselves.