'I have malaria' and 'I have anxiety' are two very different statements. The first illnesses most of us come across are invasions. Let's look at how malaria 'invades' a person (Wikipedia):
The infective stage called the sporozoite is released from the salivary glands through the proboscis of the mosquito to enter through the skin during feeding. The mosquito saliva contains antihaemostatic and anti-inflammatory enzymes that disrupt blood clotting and inhibit the pain reaction. Typically, each infected bite contains 20–200 sporozoites. A proportion of sporozoites invade liver cells (hepatocytes). The sporozoites move in the bloodstream by gliding, which is driven by a motor made up of the proteins actin and myosin beneath their plasma membrane.
The body has its response, and there are pharmacological and other interventions available.
There is the cause, the pathogen, the entry into the body, the effect on the body, and the body's response.
Malaria denotes the full range of phenomena; there is a definite difference between the before and the after, between a subject without malaria and a patient with it. Malaria exists, as a boundaried phenomenon, with a clear cause outside the individual, yet with effects within the individual.
It's a different matter with depression, anxiety, etc. I 'had' depression and I 'had' anxiety (along with other 'things', too). There are similarities with the physical disease model, but there are also differences. The verbal structure 'I have X', whilst identical for malaria and depression, belies a different relationship between the haver and the had.
The term anxiety refers to 'a feeling of uneasiness and worry, usually generalised and unfocused as an overreaction to a situation that is only subjectively seen as menacing' (Wikipedia).
Let's look at the difference between this and malaria. Is there a pathogen in anxiety? No. It is boundaried? No. Everyone on the planet, every day, at some point and at some level, will have at least a moment of uneasiness and worry that fulfils the above definition. This might be available to the consciousness of the individual, or it might not. But this is a universal feeling. When does it become a 'disorder'? When it is severe and pervasive enough to cross certain thresholds. Who decides what those thresholds are? Diagnostic manuals. The period of 'six months' is chosen; not unreasonable, but arbitrary. The phenomenon exists along a spectrum, at it is decided that, past a certain point, the phenomenon becomes a disorder, for diagnostic, treatment, insurance billing, epidemiological, and other purposes.
It should be noted that emotional states have physically correlates, in other words mental states are mirrored physiological (e.g. releases of hormones, like epinephrine, norepinephrine, cortisol), and this will then have an effect back on the mind, e.g. the amygdalae and hippocampus recording the details of the event.
Anxiety is real, in the sense that the array of related phenomena occurring under this umbrella exist. Ditto depression. Ditto many other 'entities'. The identification of such nosological entities is very useful chiefly from a diagnostic and treatment point of view, but for many other purposes.
So why am I saying all this?
I spent a lot of my life suffering from depression and anxiety. I have scored highly in screening tools for ADHD. I have autism. I spent a chunk of my childhood, and part of my adulthood, hiving off these disorders as invasive entities or occupying forces or sitting tenants, distinct entities operating within me: alien presences with their own consequential cascades and causalities lying either within themselves or beyond my reach.
My view was that I was living with these as medical conditions, as one would viral hepatitis, which I have had on more than one occasion, with symptomatic treatments possible, but with no personal responsibility involved. Once the virus is in you and replicating: you've got it. Now the depression, anxiety, and other disorders were in me, I had them. But that was the end of that. They were the scar tissue, the war wound, the gammy leg, or even the missing limb.
I would think or behave in certain ways, then project the thinking or behaviour onto the disorder and literally say, 'That's my autism' or 'That's my anxiety', etc. I wasn't wrong, in that the thinking or behaviour could be accurately classed under those headings. But there was a psychological benefit in doing this: Firstly, I was not responsible. Secondly, I should not feel guilty, and I should not be reprimanded. Thirdly, I did not have to change.
Now, there is some merit to the first and second points: the thinking and behaviour were very much conditioned, and certainly guilt would have been inappropriate; the question was not a moral one.
It is the third point that I take issue with. Change is possible. I used to have panic attacks in supermarkets because there were too many products. When I was 15 I entered an entirely non-responsive state and was hospitalised. I used to fall down mental rabbit holes that it could take me weeks or months to emerge from; I would tumble into the upside-down world like in Stranger Things and be unable to find my way out. None of these occur today.
Rather than seeing these phenomena as disorders in the sense of alien entities inhabiting me, to which I point defensively, saying 'They're real!', and seeing myself (and in fact others) as the victim of them, I now view them as something I would perform, involuntarily, but performing nonetheless.
The hand can be held up near a wall, with a light source causing the hand to project shadow images, of birds, or rabbits, of top hats, on the wall behind. Are the images real? Yes. But are they self-causing? No.
Similarly, when I wave my hand or perform other physical actions, the wave thus formed is real. But it is an extension of phenomena way upstream of the wave itself. The whole body, the whole mind, is implicated.
As a teen, I had considerable physical tension, which was affecting my musicianship. An Alexander Technique teacher was called in for me, and some others at school, to fix the postural problems (plus addressing psychological aspects), and, together with a piano teacher in London in my late teens, the postural problems were solved.
Prior to treatment, this problem had a definite physical presence, was unbidden and unwilled, and was causing significant problems. But it turned out that there were upstream interventions available. It was not my fault I was like that, but it did not have to be accepted as a sitting tenant, with its own cause, its own volition, operating like a closed system, circular and self-perpetuating, a parasitic living being.
When I look at my family, even people with very little in common in terms of upbringing and exposure to family patterns of thought and behaviour display very similar phenomena in terms of behaviour, interests, mental disorders etc.
I have absolutely no doubt that my mental challenges have a large genetic component; add to that taught behaviours; add to that traumatic events, and, voilà, you have an incendiary Molotov cocktail of thoroughly disordered mental processes and behaviours, replete with physiological causal chains and cascades.
These diagnoses or disorders are not shark's teeth on a necklace round my neck; they're part of the continuum of the single entity of me; they are part of how I can but need not necessarily perform in the world. They're not separable, divisible, firewalled circuits in their own password-protected data silos. They're not enclaves, ghettos, pockets, foreign households in the block of flats with their own language and customs, locked behind their own front doors. They're fully integrated domains of performance within a much larger system of circuits and patterns.
That's one aspect. The other aspect is the distinction between the cards dealt and the playing of the cards. It's very common to ring-fence disorders and place them outside the scope of the recovery programme or indeed any other cognitive or behavioural intervention, whilst attempting to tamp down the more disagreeable of the downstream symptoms and other phenomena, or to intervene directly at the neurological or biochemical levels. Whether or not such interventions are necessary, desirable, effective, and wise does not fall within the scope of this discussion and is of no present interest to me.
What is of interest is this idea: I am not responsible for the cards I'm dealt, but I am responsible for how I play them in the game of life.
The cards are real. Absolutely. The dealing of the cards is outside my control and lies before the ascent of my agency. But the playing of the cards is absolutely my responsibility.
Is it quick? No. It is easy? No. Does the first thing one tries work? No. Is a lot of help, a lot of trial and error, a lot of patience, are a lot of false dawns necessary? Absolutely. But let's at least begin the process.
I wasn't happy to write myself off as a lost cause or to write off my disorders as the invariant framework of my existence and experience. I proceeded on the basis that the performance of these disorders were downstream of levers and strings I had to first find and then learn to pull.
And, you know what? The agency extends not just to how the cards are played: the playing of the cards changes the cards themselves. I don't feel I'm currently playing with the same deck of cards I was dealt. A sea-change has taken place, and, whilst there are definitely residual propensities (with gloominess, rigidity, and panic responses to threats making prominent and regular reappearances), I'm not the 'hunched, wizened little old man' I was described as by a headmaster when I was 14. These propensities are like the drift on a misaligned steering wheel: constant attention is required, and the cause of the drift cannot be eliminated as one is driving along the road, but there's no reason not to drive straight down the lane with no incident.
In short, far more has proved possible in terms of acceptance, landscaping, adaptation, and outright change than I ever thought possible.