Anxiety, Worry or Fear? Disappointment, Grief or Depression?

Especially in these strange and uncertain times, many people feel uneasy. Some of them come to us with concerns over their state of mind.

In primary care, our job is in large part to perform triage. We strive to identify patients who need referral, medication or further evaluation. We also strive, or at last should strive, to reassure those patients whose reactions are normal, considering their circumstances.

A set of emotions we consider normal during the first weeks of the loss of a loved one may constitute pathology if protracted or if there is no apparent trigger.

But what is normal in today’s reality?

People today often have a low tolerance for deviations from the mean. They measure their heart rates, sleep times, steps taken, calories eaten and many other things on their smartphones. They compare their statistics to others’ or to their own from different circumstances.

Is it normal to sleep less when the last thing you do before bed is take in the latest disaster news? Is it normal to have a higher resting heart rate when you are threatened by eviction? Is it normal to feel sadness that life as we knew it doesn’t seem to be within our reach right now?

The worst thing we can do is tell people there is something wrong with them if we see them doing and hear them expressing what many other people also do.

It’s bad enough to feel bad, but even worse if you think your reaction is a sign of psychiatric illness or psychological or constitutional inferiority.

Not everyone checks in with other people if they feel the same way, and not everyone gives themself permission to feel bad.

Just like some people expect their body metrics as measured with their devices to be “normal”, many in today’s culture don’t expect to feel the ups and downs that life brings us. And right now, the “downs” seem to be piling up, to coin an oxymoron.

Just like there are people who prefer to live where all seasons have the same weather, there are those whose tolerance for emotional winters is low.

Well, snowstorms happen in Texas and hurricanes hit New York City these days. The Bell curves for all kinds of things are shifting.

We must find ways to help people see the difference between endogenous and exogenous states of emotion, and we must help each other accept that you cannot expect to feel “normal” when the world and the times are not.

We must find ways to be supportive without medicalizing valid and appropriate emotional reactions. We should probably not pin new diagnoses of anxiety and depression lightly on people right now.

Adjustment reaction with [this or that] mood seems like the way to go under these circumstances.

4 Responses to “Anxiety, Worry or Fear? Disappointment, Grief or Depression?”

  1. 1 Susan Neely September 5, 2021 at 6:06 am

    I have actually found a non-medicinal cure for anxiety.etc. He is the Lord…and He rules. I can rest!!

  2. 2 Matthew Collins September 5, 2021 at 6:32 am

    I would think that “lightly pinning” a diagnosis of anxiety or depression on a patient is never a good idea.

    However, there may be high-functioning patients who have gotten quite good at managing an actual condition despite long-term internal struggles. Exploring their history, or referring them to a trained therapist who has the time to do so, could be very beneficial.

    I recommend chapter 2 of the audiobook Greater Than the Sum of Our Parts by Richard Schwartz.

  3. 3 Regina South September 5, 2021 at 8:45 am

    Thank you

  4. 4 lcorbu September 5, 2021 at 11:19 am

    As always, well said Dr. Duvefelt. Is hard to deal with uncertainty at any time, leave alone the present time. Strongly recommended Epictetus’s pocketbook that survived 2000 years: “The Art of Living” in a new interpretation by Sharon Lebell.

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.



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