Picture yourself walking into a room, about to meet a friend. It’s someone around your age with whom you socially interact—this isn’t for business or for school, just someone that you’re meeting up with.
You sit down together and start the conversation—it feels natural and lighthearted—when all of a sudden you see that this individual’s foot is rapidly shaking. It starts at the knee and ends at the ankle, this foot shake that you feel reverberating through the floor. At this point you think about whether you should say anything, ask if everything is all right, or continue talking.
I would imagine that you don’t begin to wonder whether this person has a foot condition; there isn’t a question as to whether there is some type of medical diagnosis impacting his/her foot. Sure, there are certain biological illnesses that might cause this. More likely, though, you realize that this person is anxious.
When I use the words anxious or anxiety, I describe the common experience of feeling nervous or excited. I do not mean the official diagnosis found in the Diagnostic and Statistical Manual for generalized anxiety disorder or another subtype of anxiety.
Anxiety is experienced by all, on a spectrum and in different ways. For instance, a young woman attending a new school may experience nervous flutters in her chest or difficulty sleeping the night before she begins. This can be called anxiety, which can usually mean—as noted above—excitement, nervousness or fear. One way that this anxiety may manifest itself is that as she sits on the bus, en route to this new chapter in her life, her foot begins to shake—a physical representation of her internal experience.
And this is widely known and understood. It feels somewhat innate to be able to pick up on one another’s cues and body language, and then determine an internal experience or feeling. For instance, the slamming of a door likely represents anger. But what can this teach us? Why delve into a common manifestation of anxiety?
Just as we would not witness an individual shaking her foot and immediately ask when she’s seeing a neurologist, so too we need to remember and understand that most mental health diagnoses have behavior manifestations. Addictions to substances are not truly about the substances. Yes, these substances can be objectively addictive in nature, but not everyone develops an addiction. An eating disorder diagnosis is not truly about the food or body, although an essential element of recovery includes re-learning to eat “normally.”
All too often, people become stuck on the behaviors and forget to ask or explore the deeper meaning. I cannot count the number of times people have made comments about eating disorders, implying that it is all about weight—and low weight for that matter—rather than having the depth of awareness about the true nature of the disorder—that is about an underlying issue and experience of pain. We focus on how to “fix” the problem, relying on the behaviors/symptoms as the sole issues at play, denying the reality of how complex mental disorders can be. By doing so, we increase the likelihood of relapse; individuals who only focus on treating the symptom typically end up using the behavior again, or engaging in “whack-a-mole” by replacing the behavior with another maladaptive behavior, and continuing to ignore the underlying issue at hand.
It is true that when someone shakes her foot from anxiety, we might encourage her to take a deep breath, or focus on mindfulness and using the five senses as a means of bringing herself back to the present and being able to calmly describe what is happening, triggering the amygdala and pre-frontal cortex to work appropriately. This is true with mental health diagnosis—we do not ignore the “symptom”—it must be acknowledged and treated in whatever manner is recommended. Still, this cannot be the end of the work. In the case of the woman shaking her foot, we might ask her to take a deep breath, but would likely also ask what has led her to this, how we can help etc. So, too, it must be this way with mental health diagnoses.
In order to provide the full extent of support possible, we must ask what else is beneath the behavior, and not rely on the behavior as a means of showing whether the person is “better” or not; if that woman were to stop shaking her leg, this would not indicate that she lacks the feelings of anxiety/excitement/fear. Rather, she has likely found another way to process this emotion, has practiced communicating effectively, or perhaps she is actually having a much harder time internally because she no longer has her means of coping—the physical manifestation of her emotional state. This happens often; the individual may stop “using the behavior” but now feels worse because the outlet is gone.
By thinking of behavioral health diagnoses within the context of analogies, or by likening them to familiar patterns, we enable increased support. We do not stop short at the behaviors, but instead allow for deeper understanding and exploration, because we are able to show our depth of awareness.
By Temimah Zucker, LMSW
Temimah Zucker, LMSW is the assistant clinical director at Monte Nido Manhattan and also works in private practice in NYC. Temimah focuses her work in the field of mental health, eating disorders and body image and speaks nationally on these subjects. To learn more about Temimah, visit www.temimah.com.
