This issue of Psychiatric Annals is focused on anxiety disorders of childhood and is guest edited by Eric A. Storch, PhD. Our readers may remember that we covered child abuse a few months ago and saw data recording the high rate of sexual and physical abuse from parents. Now we are confronted with the significant rates of anxiety disorders that emerge in childhood and adolescence. This may issue from the hand dealt to the child from genetics interacting with stresses of life often also dealt to anyone who is living in this seemingly random universe. The illusion of the protected happy childhood seems to be a relic of the 1950s. Life is a serious challenge from our beginnings — genes and circumstance. From the moment we are born, the dice have been thrown.
If we come up with bad genes or bad circumstances within our first 10 to 15 years of life, what are the available remedies? What are the means by which we can become at least partly whole? It is pointed out in this series that there are medications that can mollify our symptoms and, if we take them faithfully, can suppress our overactive amygdales and limbic systems over time. These can somewhat modify the curse that God threatened us among the 36 curses for disobedience in the Biblical Book of Leviticus: “The sound of a driven leaf shall put them to flight ... fleeing as though from the sword, they shall fall, though none pursues.”
Was God referring to the short allele for the serotonin transporter that may increase an person's vulnerability to developing anxiety and depression? If so, why did only a portion of us inherit it? Of course, there are a host of bad genes we can be dealt.
The authors of this series offer another approach to various childhood anxiety disorders covered in this issue to counter this potential curse — cognitive-behavior therapy. They cite evidence of the effectiveness of this therapy in children and adolescents with anxiety disorders. Yes, one can raise questions about the measure of outcomes — the number of patients who meet criteria for an anxiety disorder after treatment versus the severity of anxiety symptoms remaining and the amount of disability remaining, and the question of response versus severity of the disorder — but the message should be clear. Patients of all ages, from young children to adults, may be able to learn lasting lessons from cognitive therapy, which confers on them the capacity to fight off the symptoms of anxiety or depression they have suffered from despite the genetic hand they were dealt, or the random bad luck they suffered from in the form of a hostile environment.
When I started my career, I felt that psychoanalysis, the only game in town, ignored medical science, and I was swept up in the psychopharmacologic revolution. Now in psychiatry, we have made a 180-degree turn, helped by medical economics, and have been pressured to abandon a part of our heritage: the use of communication and relationship to heal our patients. While this was happening, cognitive therapy, pursued relentlessly by Dr. Tim Beck and those he recruited, has shown that patients can learn lasting lessons to help them free themselves from the curse of anxiety and depression. Skilled medication therapy is still indispensable at times, but if a patient can learn to recover from the curse of anxiety and depression through this empirically derived treatment, maybe we should add it to our treatment arsenal.