Ellen Vora - The Anatomy of Anxiety

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For my mom

We are on the cusp of a significant shift in how we view and treat mental health. Over the last several decades, the emerging fields of functional and integrative medicine, nutritional psychiatry, and even psychedelic therapy have shone a light on new paths to better mental health. These disciplines have demonstrated that issues wed once considered purely psychiatric in nature can be better understood as the result of a delicate yet highly consequential interplay of body and mind.

In my own work as a holistic psychiatrist, for instance, I examine the whole portrait of my patients livesfrom what they eat; to how they sleep; to the quality of their relationships; to where they find meaning, purpose, and refuge in their lives. In doing so, I have found that the anxiety that plagues so many of us is increasingly caused by the habits that are now intrinsic to our modern lives, such as chronic sleep deprivation, poor nutrition, and even doom scrolling on social media late into the night. Though these issues may seem too benign to significantly affect the mind, they are capable of creating a stress response in the body, which prompts the release of hormones such as cortisol and adrenalinesignaling a state of emergency to the brain that can leave us feeling anxious. In other words: physical health is mental health. And anxietythat hypervigilant feeling that escalates swiftly to a sense of catastrophe and doomis as grounded in the body as it is in the mind.

This paradigm shift is, in my view, as revolutionary as when selective serotonin reuptake inhibitors (SSRIs), a class of antidepressant medications including Prozac and Lexapro, were introduced a few decades ago. When these medications became the mainstream treatment for depression and anxiety, a clear medical model was presented for psychiatric disorders, and public mental health awareness grew. After centuries of stigma and shame, this came as an enormous relief; it offered the notion that our mental health struggles are not based on our personal failings but are essentially an expression of our brain chemistry. Now, however, given our increasing understanding of the profound mind-body connection, we have even more avenues to explore, in addition to medication, for addressing mental health. And in understanding that the body is as capable of informing our moods as the brain is, we have also come to realize that our anxiety is far more preventable than previously known. That is, through relatively straightforward adjustments to our diet and lifestyle, we can avoid unnecessary stress responses and head anxiety off at the pass.

There is, of course, a more profound anxiety that exists beyond the physiologicaland this feeling of uncertainty and unease cannot be addressed quite so easily. Ive found, however, that once Ive worked with my patients to eliminate the first layer of physical anxiety, the way is cleared for us to tap into this more penetrating distress. When my patients are able to discern the message of this deep-seated anxiety, they often find that it is their inner wisdom sending up a flare that something is out of alignment in their lives, either with their relationships or jobs or in the world at large. It sometimes speaks to our estrangement from community or nature; at other times, it points to a lack of self-acceptance or a keen awareness of the grave injustices happening around us. Exploring this anxiety allows us to excavate our intimate truths. And more often than not, these revelations offer a call to action as well as an opportunity to turn a feeling of profound disquiet into something purposeful.

In this sense, whether its the consequence of our habits or a missive from our inner psyche, anxiety is not the final diagnosis but rather the beginning of our inquiry. That is, anxiety is not whats wrong with youit is your body and mind fiercely alerting you to the fact that somethingelse is wrong. It is evidence that there is something out of balance in your body, mind, life, or surroundingsand with curiosity and experimentation, you can work toward putting these elements back into balance. The path forward begins with identifying the root cause, whether it is the result of an everyday habit or a sense of profound unease or both.

I come by these revelations honestly. My years in medical school at Columbia University and my psychiatry residency at Mount Sinai were not halcyon days for me, largely because my arduous training was complicated by my own mental and physical health problems. I struggled with mood as well as digestive, hormonal, and inflammatory issuesproblems that I now know conventional medicine is fundamentally ill equipped to address.

It took me years to regain balance within my body and life. Ultimately, in the final year of my psychiatry residency, desperate to bring more meaning to my work as well as to discover a way to heal myself, I began studying alternative approaches to health in addition to my rotations at the hospital. When I wasnt working overnight on the wards, I attended acupuncture school and then took shifts administering acupuncture to patients at an addiction clinic in the Bronx; I used my elective time to complete the integrative medicine training at Andrew Weils center at the University of Arizona and then had a mentorship with an integrative psychiatrist back in New York; I apprenticed with a hypnotherapist; I undertook intensive yoga teacher training in Bali, where I was also introduced to Ayurveda; and, in time, I went on to study functional medicine and explore psychedelic medicine and its potential implications for psychiatry.