When is anxiety a mental illness (and when is it not)?

Just before a performance of Crystal Pite's wonderful dance/theatre piece Betroffenheit the other night, we attended a pre-show talk about how the arts can help mental illnesses. It sounded like an interesting topic, but I have to confess, we both walked out before the end. We felt a bit shame-faced in leaving, but we felt we couldn't stay.

I think that what we both found difficult was some of the terminology and buzz-words and -phrases that kept coming up, words like "victim" and "survivor", and hackneyed phrases like "I didn't see anyone like me when I was growing up". Maybe it's just a generational thing - young people just didn't seem to have mental health problems when we were growing up (well, I'm sure they did, but it wasn't talked about, and people were just expected to "deal with it", and did). Which might be something to with our lack of patience with young people today, even though we know intellectually that there is a lot more mental illness around than there might appear, and that we should be patient, supportive and empathetic with those who suffer from it.

The two earnest young women at the pre-show talk both talked about their anxiety issues, something that seems to have reached almost epidemic proportions recently, particularly among millennials. My daughter (as well as most of her friends at university) also has anxiety issues, so I have tried to understand it, but I'm still not quite there.

Part of the problem is getting my head around the difference between anxiety (which everyone experiences from time to time, some more than others) and an anxiety disorder. Most people get anxious before exams or interviews, and are stressed when faced with what seems like an overwhelming workload or an impractical deadline. This is not a mental illness, and people do just need to "deal with it" or "get over it", although they can be helped and supported through it to some extent. However, that is the last thing that one should say to a person who suffers from a bona fide anxiety disorder. What anxious or depressed people do apparently want to hear are things like: "It's OK not to be OK", "I'm here for you", "You're doing really well", "You have the strength to beat this", or just "I love you".

If someone has an anxiety disorder, there are a bunch of other considerations and misconceptions to take into account, including: it's not possible to just "snap out if it"; there isn't always an obvious reason or catalyst for an anxiety attack; it often comes with physical effects such as nausea, stomach ache, headache, heart palpitations, etc.; therapy and/or medications may help, but equally they may not.

Obviously, there is a big grey area between and around normal anxiety and an anxiety disorder. There are some general indications of a true anxiety disorder (e.g. the intensity and length of the anxiety; associated physical symptoms and a feeling of disconnection from reality; impairment or avoidance of everyday activities; etc). But there is also the problem of self-diagnosis (otherwise known as Google), and the possibility that some of the symptoms are actually psychosomatic and (dare I say it?) not real. It's a minefield.

I often find myself pussyfooting around my daughter, not wanting to sound callous, and keen to give her the benefit of the doubt, while inside I am probably thinking along the lines of, "Oh, come on, get over yourself, I did exams too, you know, they're stressful but you can cope with them". Certainly, using the "mental health card" is a failsafe way of closing down an argument or an uncomfortable conversation.
I do sometimes wonder whether we are not condoning and enabling a kind of victim culture. But I'm way too polite and sensitive to say so. Ooh, di I just say that out loud?

UPDATE
Interestingly, the Globe and Mail's respected health columnist André Picard dealt with this very same subject just a month after I wrote this piece, and came to largely the same conclusions.
Picard was commenting on a Sun Life Financial poll that concluded that 49% of Canadians have experienced a "mental health issue" at some time in their lives, including 63% of millennials, 50% of Gen X'ers, and 41% of late boomers. The preponderance of younger people reflects the fact that recent generations are more willing to talk about or admit to mental health issues, which is surely not a bad thing. But the bald statistics do need unpacking a little.
For example, what is a "mental health issue" and is it the same as a "mental illness"? Probably not - 63% of millennials have probably not been clinically diagnosed with a mental illness. However, 63% (and probably nore) may well have been stressed, anxious or depressed at some point. This is a normal part of modern life, and having feelings and emotions is not in itself problemmatic.
As Mr. Picard says, "What the poll tells us, more than anything else, is that we are pathologizing normal emotions ... It's normal to be anxious in certain situations ... It's normal to be depressed sometimes ... It's normal to be stressed sometimes ... There can sometimes be a fine line between being anxious and suffering from anxiety, and between sadness and depression."
Quite. I couldn't have put it better myself, and indeed I didn't.