A Review of
The Anatomy of Anxiety: Understanding and Overcoming the Body’s Fear Response
Reviewed by Wendy Kiyomi
“Chronic constipation,” our pediatrician once told me, “is much more common in kids with ADHD than in kids without.” I was surprised. I was used to thinking of ADHD as primarily a mental condition that had no connection to the bowels at all. “They don’t have time to poop,” she quipped. It was a simplistic explanation, but it made me think about what constant digestive discomfort meant for a kid’s ability to deal with the daily issues of impulsivity and inattention. Wouldn’t it make it harder?
The way that the body and brain work in tandem to create what we call mental health is at the heart– or shall we say, the gut– of Anatomy of Anxiety by psychiatrist Ellen Vora. Anxiety is broadly defined as an “anticipation of future threat” by the Diagnostic and Statistical Manual of Mental Disorders. Most of us know what it’s like to feel uneasy in our mind and then experience it in our bodies: queasiness getting called to the principal’s office or needing to pee right before a swim race.
These signs of unease travel from our brain to the abdomen via the vagus nerve, a long nerve comprising thousands of fibers that touch every organ system in our body. Clinically, anxiety is usually treated as originating in and affecting our mind, but Vora wants to alert us to the fact that the vagus nerve is equally busy transmitting information in the other direction. Most of our immune system resides in our intestines and is heavily influenced by food, gut microflora, and stress hormones. This gut immune system acts like a second brain. When it is not calm and healthy, the brain hears about it and reacts accordingly, resulting in what we understand to be anxiety. It’s not, she says, just in your head.
Following the COVID pandemic, the number of people reporting symptoms of depression and anxiety has increased 270%. It’s worth paying attention to the millions of bodies and minds that are suffering. A major contribution of the Anatomy of Anxiety is letting us see that what we experience as anxiety often stems from physical causes, such as poor digestion, sleep deprivation, stress, and chronic inflammation. Vora calls this false anxiety, not to minimize its impact, but to underscore that it is preventable and often reversible.
For the church, the phenomenon of anxiety can prompt something deeper: a profound valuation of our embodiment. Christians already believe that the body has inherent worth as created by God and destined for glory. Reframed, anxiety is an unwelcome sign that we are fearfully and wonderfully made: the care and feeding of our own bodies and those of the most vulnerable members of our communities is even more important than we realize. Anxiety is a case study in how our bodily health affects our thinking and beliefs. For Christians holding a high view of the body, the idea that bodily health might impact even our moral development is not a bridge too far.
Relationships and social conditions are all mediated through our bodies and shape our mental health as well. We can’t live without meaningful relationships, “at least not without cognitive decline, decreased longevity, and anxiety,” Vora writes. The quality of our families, friendships, and communities, especially in early childhood, stays with us. Early life is a “blueprint for community,” and encodes the quality of our relationships over an entire lifetime. This has special meaning for some of the children I care for, who had distressing experiences leading to foster care as toddlers and infants. The chaotic care they received in crucial early years affects them for life – they carry their relational blueprint in their very bodies, often making it hard for them to love and be loved. In light of this reality, therapeutic foster care and adoption by Christians are difficult callings but important to the heart of God, who is near to the brokenhearted.
Vora moves on to describe true anxiety, that is, anxiety that isn’t resolved once physical health issues are addressed. True anxiety will still affect some of us some of the time. We are fragile creatures in a fallen world; danger and injury are unavoidable. Vora has a sweet ability to frame anxiety not as a problem per se but as an opportunity for hope and curiosity. Anxiety is not something wrong with you, on the contrary, it is your body “alerting you to the fact that something else is wrong.” This doesn’t make the experience easy or pleasant, but it does have a purpose. We are well served by viewing anxiety “not as the final diagnosis, but as the beginning of inquiry.”
Vora is critical of psychotropic medications to treat anxiety and tells of the difficulty of getting off such drugs and of long-lasting effects even after discontinuing their use. Instead, she encourages a broad body-based, mindful therapeutic approach to sleep, nutrition, stress management, social connection, and other practices.
While readers with persistent or intense anxiety may find new meaning from Vora’s affirmation that anxiety has something important to say, they may find that Vora’s approach to true anxiety falls short. With such an emphasis on rooting out physiological causes, anxiety-sufferers can wear themselves out scrutinizing every aspect of their body care, even blaming themselves for failing to find a cure. Psychotropic medications are sometimes the best answer, and many can be used safely.
Reading as a crop scientist, Vora’s book would have been better without her speculation that glyphosate (Roundup™) on the US wheat crop is to blame for increased rates of anxiety. Glyphosate has been shown in laboratory rats to compromise gut function and thus may be a contributor to anxiety symptoms. However, wheat is not a GMO crop in the US and is not “Roundup ready;” most producers don’t use glyphosate on standing wheat crops. She provides no data for this assertion and displays a simplistic understanding of the very food supply that she advocates examining in order to eat an anti-anxiety diet.
She makes an important point here, though: eating and every other contact our bodies make with our environment affects our mental health. The Doritos I eat while relaxing may not be doing me any favors. It matters how we produce food and manage our soil. Even seemingly neutral choices that involve the body can be part of our inquiry into mental health. Do we learn from books or screens? Do we drive or do we walk? Do we give our middle schoolers smartphones? How do we use our own phones?
Anxiety truly has an anatomy and brings us to the beginning not only of inquiry but also of compassion. There are good reasons for hope in addressing this debilitating condition that people are struggling with. The church, which already takes bodies seriously, has a major role to play in cherishing the body/mind connection as an expression of God’s goodness for all people.
Wendy Kiyomi is a plant scientist, church leader, and adoptive parent living in Tacoma, Washington, whose writing intersects theology, friendship, suffering, and adoption. Her work has previously appeared in Plough and various journals of plant science.