Government Therapy

Is the “Solution” the Problem?

For the first time in its history, the U.S. Preventive Services Task Force (USPSTF), a medical advisory service to the federal government, has recommended a national program to screen all adults under 65 for anxiety disorders. It would ideally happen as part of every annual health checkup, says Dr. Lori Pbert, a task-force member and professor at UMass Chan Medical School.

Generalized anxiety disorder, panic disorder, social anxiety, separation anxiety, and phobias would all be targeted. Citing U.S. data collected from 2001 to 2022, the Task Force warns that 26.4 percent of men and 40.4 percent of women will suffer from at least one of these conditions over the course of their lives. And because anxiety disorders are currently unrecognized in primary care settings, it argues that continued lack of universal screening will effectively deny needed treatment to millions of Americans.

For universities with graduate programs in psychotherapy, the recommendation is obviously good business. As Dr. Pbert herself admits, providing services to those flagged by a nationwide screening program would require a vast increase in the number of clinical psychologists, psychiatric social workers, and related professionals. “We know that we have an undersized mental health care workforce,” she says. “We’ll need to expand that workforce to meet the demand.”

Cause for Pause

But for those with some historical perspective on various approaches to treating anxiety, there is ample reason to question the wisdom of universal screening.

First, the record of conventional psychotherapies in reducing anxiety, even among people who have sought counseling without the prodding of a required test, is not very impressive. The USPSTF itself “concludes with moderate certainty that screening for anxiety in adults, including pregnant and postpartum persons, has a moderate net benefit.”

As to the effectiveness of psychopharmacologic drugs, such as antidepressants and benzodiazepines, they do help some people. “But,” as Wall Street Journal columnist Daniel Henninger recently noted, “that raises an age-old question similar to administering drugs for ostensibly hyperactive boys in grade school: Would anxiety screening put many more millions on a lifetime regimen of pharmaceuticals?”

Second, the literature on anxiety, both before and after the rise of so-called “scientific” psychotherapies in the early twentieth century, strongly suggests a spiritual aspect to the disorder, especially among long-term sufferers. More specifically, it argues that persistent nervous feelings for which there is no immediate or rational explanation frequently stem from a rupture in one’s relationship with God.

Restlessness of Heart 

St. Augustine’s most oft-quoted phrase, which comes down to us in the form of a prayer from his Confessions, is, “You have made us for yourself, O Lord, and our hearts are restless until they rest in You.” Many other great Christian teachers have similarly viewed anxiety as a sign that believers were wavering in their faith, as did the influential twelfth-century Jewish physician Moses Maimonides, who wrote in his text on mind-body connections, Regimen of Health, “Let a person replace anxiety with hope [in God] and with this hope it is possible that in fact the opposite of what one fears will actually happen.”

Up until World War I, when almost every American college and university was still affiliated with a Christian denomination, clerical presidents often taught an upper-class seminar on how to deal spiritually with the various problems students were likely to encounter after graduation. A central teaching in these courses was the need to respond to every new fear or setback by remembering that, in the words of Yale President Noah Porter (1871–1886), “He who has brought you to this place will guide you to the end.”

The lesson was no different at women’s colleges. “We often make ourselves unhappy by dwelling on our condition and prospects, and those of our friends,” President Mary Lyon (1837–1849) told her Mount Holyoke students. “But it is our blessed privilege to commit all these to Him, who will certainly take care of us, if He sees we are not afraid to trust Him.”

It is true that most pioneers of what we now think of as psychotherapy—the early twentieth-century medical school psychoanalysts and psychology-department behaviorists—did not share this metaphysical view of anxiety. Yet the notion of a spiritual cause has never completely disappeared from the professional literature.

Harvard’s first psychology professor, the philosopher William James, who struggled his entire life with religious faith, was at least able to settle on a concept of mental health which required accepting one’s place in a universe beyond logical comprehension. “Ascend to some sort of partnership with fate,” he wrote, “go to meet it, work it to our needs, instead of dodging it all our days, and being run down by it at last.”

Having spent much of his own career trying to understand why so many people suffer from anxiety, psychoanalyst Carl Jung eventually came to see the disorder as a sign of unwisely resisting a change in one’s calling. He believed that each person is presented with a series of life tasks not of his or her choosing—some biologically determined, others culturally absorbed, and still others divinely commanded. Neurotic anxiety, according to Jung, comes from resisting one of these tasks for any length of time. 

Attending to “True Impressions”

Coming down to today, the notion of anxiety as a symptom of spiritual misalignment is an important theme in the contemporary revival of the ancient Catholic ministry of spiritual direction. Once offered exclusively by ordained priests, this practice of attending to God’s presence and call through silence, frank conversation with another believer, and a principled relationship with the larger world has proved increasingly popular with Anglicans and many Protestants.

These considerations raise the possibility that a government program might not only waste money on marginally effective secular treatments but, by promoting a policy that narrowly fixes anxiety as a medical or solely psychological condition, also actually aggravate the disorder in many people. For, as the novelist Saul Bellow famously observed in his acceptance speech for the 1976 Nobel Prize in Literature, the greatest difficulty moderns have in dealing with the spiritual lies not in having a sense of it, but in the lack of a publicly comfortable language for speaking about it.

We all have glimpses of the spiritual realm, Bellow noted, “what Proust and Tolstoy thought of as ‘true impressions.’” And,

[W]e never seem to lose our connection with the depths from which these glimpses come. [But] we are reluctant to talk about this because there is nothing we can prove, because our language is inadequate and because few people are willing to risk talking about it. They would have to say, “There is a spirit” and that is taboo. So almost everyone keeps quiet about it, although almost everyone is aware of it.

Of course, a government screening project could avoid fostering an exclusively materialistic definition of anxiety by simply acknowledging that many people have found help through a closer relationship with God. It might even be legal to fund the expansion of clinical programs with a pastoral-care component and require physicians to make their patients aware of spiritual treatment options. But in today’s world, such proposals would almost surely ignite political controversy, and the USPSTF gives no indication of being ready to cope with that kind of anxiety.

Fortunately, there is nothing to stop any believer who has turned his or her fears over to God from joyfully reporting the results of that treatment protocol.