The Bemusing Triangle - anxiety, depression, insomnia

“Chronic insomnia is a marker of both anxiety disorder and depression”

Dag Neckelmann, MD, PhD

The irony of the human condition is that we are protected by the very same phenomenon that can seemingly turn against us. Our subconscious defences against any threat, real or imagined, are nicknamed "fight and flight", and these are our options:

• if the threat is manageable, we can fight it
• if the threat is too dangerous, we can escape it.

The behaviour triggered by this primitive area of the subconscious mind is impossible to ignore because the body responds to danger automatically, releasing adrenaline. The heart and breath rate increase to allow more oxygen into the system; the blood flow carries oxygen away from the central organs and into the limbs and the brain to prepare for action and quick mental responses, which means that functions such as digestion are temporarily stalled until we feel safe enough to allow the body to return to homoeostasis.

This built-in survival program is suited to a simple, primitive world, where the strongest and fastest survive, but the modern world is complicated. It is not acceptable to punch your boss, (fight) or run screaming from your office, (flight) no matter how strongly you feel the desire to do so. As a result, the natural defences are suppressed, and become dysfunctional.

• When the "fight" reflex is suppressed, energy that would have been exhausted by fighting remains unused, and we feel trapped and desperate.
  "Fight" becomes anxiety
• When the "flight" reflex is suppressed, the subconscious mind tries to escape, to remain unseen, attempting to hide from the threat, like hibernation.
  "Flight" becomes depression

• An individual who's "fight" reflex has been triggered and who is suffering with anxiety, will experience episodes of depression, as the subconscious mind becomes overwhelmed by the attempt to fight, and switches to the opposite defence tactic in an attempt to survive.
  Anxiety becomes depression
• An individual who's "flight" defence has been triggered and who is suffering with depression, will experience episodes of anxiety, as the subconscious mind switches to desperation in an attempt to escape.
  Depression becomes anxiety

"Anxiety and depression may seem like opposites, but they are really opposite sides of the same coin."

John Kappas, PhD

The Bemusing Triangle

After the threat has been removed or defeated, or we have escaped out of harm's way, we are designed to return to homoeostasis through the natural process of dreaming. Sleep allows the body to heal, and the mind to dream. Dreaming allows the subconscious mind to unpack the traumatic events that have occurred, to understand what has happened, accept that the threat is over, and move on with life. But if anxiety causes depression, and depression causes anxiety, how is anyone supposed to sleep with so much adrenaline coursing through the brain?

"If we do not sleep well, we can not dream effectively. If we do not dream effectively, the mind becomes overloaded and unable to cope through the day."

John Kappas, PhD

Sleep deprivation studies (W. Dement, 1960) have shown that the effects of insomnia are short temper, emotional sensitivity, introversion, and social discomfort, characteristic symptoms of anxiety and depression. Insomnia is not only an effect of anxiety and depression, it can also be the cause. The bemusing triangle now appears:

• Anxiety can cause depression and insomnia
• Depression can cause insomnia and anxiety
• Insomnia can cause anxiety and depression 

Continue reading...