Your Anxiety Isn’t All in Your Head

Your Anxiety Isn’t All in Your Head

An Interview With Ellen Vora, MD

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Ellen Vora, MD, is a psychiatrist, a yoga instructor, an acupuncturist, and a witch—and she’s on a mission to radically change the way we approach mental illness.

Her groundbreaking new book is The Anatomy of Anxiety: Understanding and Overcoming the Body’s Fear Response.

You took a winding path to become a psychiatrist.

Yes, a winding path indeed. The way we always look back on these things is to make it a hero’s journey, to ascribe some meaning to this struggle. But at many points along the way, it was truly just a mess. [Laughs] I was in medical school at Columbia and in crisis. I was out of balance physically and out of balance mentally. I was going to see various conventional doctors and saying, “This hurts! Something’s not right here.”

But I would always have healthy, normal labs. So, they would say, “Nope, you’re fine,” which is truly invalidating when you don’t feel fine. I was also in crisis in terms of the tools that I was being taught to use to help my patients. I saw my patients get more and more heavily medicated, but they were not thriving. So, I was really in crisis in terms of my identity as a healer, and at various points I thought about quitting.

“I was an English major at Yale, and somebody could have saved me a lot of trouble and soul searching if they had just told me that nearly all English major pre-meds go on to become psychiatrists.”
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What helped?

A variety of interventions were recommended, but one outclassed them all: yoga. I was always racing zero to 60—full overwhelm all the time. Just being on the mat and coming back to my breath enabled me to retain a through line to mental equanimity in the face of challenge. Yoga taught me that I could breathe through any crisis.

My yoga practice also gave me the space to allow my real questions to become clear: How do I have autonomy? And how can I have my day-to-day life and work deeply embedded in the human condition? My right answer wasn’t going to be something like nephrology or dermatology.

I was an English major at Yale, and somebody could have saved me a lot of trouble and soul searching if they had just told me that nearly all English-major pre-meds go on to become psychiatrists. Part of me wanted to just stay in the humanities, and psychiatry is the most humanities-adjacent medical specialty. The gray area of human existence captured in literature was absolutely the right fit for me. When you approach medicine in this more narrative way—where symptoms are sometimes the physical body communicating something about somebody’s more psychospiritual needs—we’re all psychiatrists.

You became a yoga teacher as well as a doctor. You also became an acupuncturist. How did that fit in?

In my fourth year of medical school, I had this intuitive hit that I must study acupuncture. I didn’t know where it came from. I had never gotten acupuncture. I really knew nothing about it, but I decided rather than push away the intuition, I would see it through. I remember it as my first conscious relationship to my intuition. Until that point I didn’t embrace my intuition; I didn’t want to be seen as irrational. I didn’t want people to mock me. It was also my first experience that when you heed the call of your intuition—when you step onto that path—you tend to find that the pieces you need fall into place.

Almost immediately, someone introduced me to an internist at Mount Sinai who liked to teach med students acupuncture. Then she connected me to a hospital in the Bronx that had a training program for a substance-abuse protocol with acupuncture. In exchange for helping out in their detox clinic, they taught me the protocol. It was such a refreshing change from how my regular medical training was going. Acupuncture felt so humane and slow and patient—and patients always left feeling a little bit better.

Do you use acupuncture on your patients?

Yes. Absolutely! What works best when you’re sitting in chairs, face to face in therapy, is auricular acupuncture: needles in the ear. If you look at the ear, it’s what’s called a somatotopic representation of the whole body—like a homunculus. The ear is essentially the fetus in the womb upside down. That’s how it maps to the brain, and it’s a validated system. For example, you can stimulate the so-called knee point in the ear and it will light up in our parietal cortex in the area associated with the knee.

Acupuncture is a really helpful tool in therapy. If someone is anxious or panicking, it can be calming and grounding. If they’re inhibited or blocked, it’s a sneaky little trick to help disinhibit somebody. A person may come in saying, “I’m fine, I’m fine. Everything’s fine.” Then, after the needles, suddenly tears are flowing and they’re talking about something their brother said when they were eight that’s still painful.

“I was thinking about what the world needs most, and it feels like if you drop a litmus strip into the stew of modern life, the pH is anxiety.”

Why a book on anxiety? What brought you to that?

I could talk forever about depression or bipolar disorder, and at this point I’m very interested in psychedelics and how they pertain to mental health. But I was thinking about what the world needs most, and it feels like if you drop a litmus strip into the stew of modern life, the pH is anxiety. That’s where people are at right now.

My larger goal is to bring people on a journey of thinking about mental health in a completely different way: an embodied way. So much healing happens by making slight adjustments in how people feed themselves, their relationship to their phone, what time they go to bed. Basically, I’m interested in, “What’s going to make you come take this journey with me?” And these days the word anxiety will open people to learning more. But I think that the solutions are universal. If I wrote a book on bipolar or on depression, my strategies would be similar.

You write about false anxiety and true anxiety. Could you talk about that?

I worry now that some people hear “false anxiety” and feel it as invalidating—and that’s certainly not my intention. I think of false anxiety as avoidable anxiety, where the underlying cause is something preventable and avoidable. The false anxieties may be really burdensome in our lives, but the underlying cause is not something essential to our being or our fundamental human needs.

False anxiety might be a way the body is saying, “We’re inflamed, we’re under attack!” It may be cytokines communicating to the brain that there’s a war going on in the bloodstream. And all the brain can do is respond, “Hey! High alert! Feel this! Address this!” We think everything in our life is falling apart, but sometimes it’s just our brain communicating to us that something is physically out of balance. More often than not, the cause is something like blood sugar, and understanding the cause gives us a path out of that anxiety. For example, if coffee is giving you panic attacks, is that essential? As much as you may love coffee, do you want to die on that hill?

“We think everything in our life is falling apart, but sometimes it’s just our brain communicating to us that something is physically out of balance.”

Do I have to answer?

[Laughs]. Some people are ready to make gradual adjustments to their caffeine consumption—or to their diet to keep their blood sugar stable or to become less inflamed. There are all these basic aspects of modern living that get us physically out of balance—and cause untold amounts of anxiety and suffering. But once you recognize the problem, there’s a relatively straightforward path out of that suffering.

Our true anxiety, on the other hand, is really our purposeful anxiety. And that isn’t the fault of caffeine or inflammation or a gut dysbiosis. And it’s also not the fault of a genetic chemical imbalance. True anxiety is not something wrong with you. It’s not pathological. Instead, it is your body communicating a very important truth, which is that something’s not right here. Something’s not right in our work or in our relationship or in our community or in the world at large. And that anxiety is asking us to take notice and take steps to remedy the situation.

It’s hard for us to discern what’s our false anxiety and what’s our true anxiety. And if it’s too difficult, we can just start by chipping away with some of the likely false anxieties and eventually most of us get to a point where you can kind of see what remains. To borrow an analogy from Glennon Doyle, true anxiety doesn’t have that high-frequency trill of fear. It’s got a lower vibration, a longer wavelength. It’s a deep inner knowing or intuition that something is not right. And it feels purposeful: something we feel driven or motivated to take action around.


In my practice, I start with the assumption that anxiety is a blood sugar issue until proven otherwise. I am not being dismissive of people’s very real suffering, nor am I implying that everyone with anxiety is diabetic. The truth is that blood sugar is not binary—you are not either diabetic or perfectly healthy. For many of us, our bodies are operating somewhere along a spectrum of dysglycemia, in which a subtle subclinical impairment with blood sugar regulation causes us to swing up and down throughout the day, with every blood sugar crash generating a stress response.

Given that the modern diet is so blood sugar destabilizing, these stress responses are at the root of much of the anxiety I see in my practice. And I’ve found adjustments to blood sugar to be among the most immediate and effective salves for anxiety. If you’re familiar with the experience of being hangry, then you probably also get hanxious, meaning you get anxious when your blood sugar is low.

Excerpted from The Anatomy of Anxiety: Understanding and Overcoming the Body’s Fear Response by Ellen Vora, MD. Published by Harper Wave.

That’s lovely. Let’s talk about spirituality and religion.

Sure. This has been an interesting journey for me. Where I grew up in the New York City suburbs, belief was a dirty word. The rare person secretly had a relationship to religion, but it wasn’t something that they talked about or wore proudly. My community wasn’t seeing each other at any sort of worship service on the weekends. My friends were cool: They read books, wrote poetry, smoked weed—and they were atheists. That was the way to be. And I—a good, people-pleasing chameleon—was like, okay, me too.

So I didn’t have to rebel against or heal from any kind of organized religion that caused harm. But coming to spirituality in adulthood—arriving at my own version of belief in a way that feels true for me—has been a gift. The journey has been ecstatic and incredibly helpful. And I am hopeful that I’m at least opening up that line of inquiry for the readers of my book.

I don’t mean to force anything. I don’t need everyone to go gluten-free and start believing in God. But one thing that I have found to be particularly helpful is having some relationship to a feeling of meaning in the unfolding of the events around me: having a stance of awe at the universe. And I do think that some versions of anxiety stem from a feeling of this being just a material, random existence—where death is the worst-case scenario. I think that’s a very anxiety-provoking state of mind.

I have learned through my own life experiences that even when the worst-case scenario happens, there is still meaning that I can trust and feel guided by. I feel loved and supported even when things are challenging—and that has been very soothing to my own anxiety. And so I’m hopeful that at least some readers can try that on for size and find a little comfort in it.

“Anxiety is in many ways an exaggeration of our survival instinct—forage for food, prepare the nest, and be on the lookout for predators and disasters.”

Is there an experience that started this process for you?

Yes. It actually started when I went to Bali to do my yoga teacher training. I know that sounds like an Eat, Pray, Love cliché, and it was. [Laughs] Finding acupuncture was my first conscious relationship to an intuitive hit, and it was reinforcing. So I started to say, “Okay, when I get an intuitive hit, I can trust it.” And then I had an opportunity to take a month to study yoga in my medical training. I could have gone to the yoga studio down the street, but I was leafing through websites and I felt completely drawn to one particular training in Bali.

When I landed there, everything about it felt auspicious: synchronicities and kismet abounding. I started to understand that tingling feeling—that feeling of salience that says, “You’re on the right path, keep going!” And there was a woman, one of the instructors, who called herself a witch, which I thought was so funny. But by the end, I was calling myself a witch. And I realized I had been denying these powers that I had. And they were beautiful. They were agents of healing. So, I started to really embrace the fact that I am a witch and to feel lucky to be one.

I also started to recognize it in others. Perhaps most importantly, I started recognizing when someone else is a suppressed witch. They’re a witch, but they don’t know it, and so they’re not living accordingly. I think that allowed me to start trusting magic and start having a relationship to it. I became much more attuned to energy: all the New-Agey terms that get an eye-roll until you’ve had your own felt experience with it. And then you’re like, “Yep, it’s real.”

That’s what happened for me in Bali, and it’s just grown and flourished since then.

Anxiety Catnip

Our constant availability through technology has robbed us of a sense of accomplishment, and instead, we are in a ceaseless race to get to the end of an infinite to-do list. Even for people with relative abundance, there is no more enough. Anxiety is in many ways an exaggeration of our survival instinct—forage for food, prepare the nest, and be on the lookout for predators and disasters. In our modern work world, this drive toward preparation and survival can go on endlessly. And the resulting feeling—that we could always be doing more—is anxiety catnip.

Even our relaxation has taken on a sense of striving. That is, we meditate for better focus. Go to bed early so we can be clear-headed for our meeting in the morning. … We now see leisure as a function of increasing output. And therein lies the rise of the wellness industry—or the “productive relaxation” industry. … Our leisure itself has become exhausting.

Excerpted from The Anatomy of Anxiety: Understanding and Overcoming the Body’s Fear Response by Ellen Vora, MD. Published by Harper Wave.

“Witch” is a big word that means a lot of things. What does it mean in your practice?

I used to sit across from my patients and the only valence on which I thought we were interacting was the intellectual valence of words. They would say things, and I would listen to the words and respond in words. Maybe I did a bit more than that because therapists are instructed to listen between the lines, to pick up on body language. You’re basically trying to find the resistance, like when somebody looks away or puts on a defensive body posture when you bring something up. Then you realize, that’s where the money is. It’s guarded. It’s tender. It’s something that’s not comfortable to open up.

But all of that may be just a very tiny bit of the energetic exchange between a therapist and patient. At this point, the words being exchanged are like my eighth priority. I don’t know exactly what brand of energy work I’m doing. You could call it reiki, or general-purpose energy work. It’s a little different with everyone, but I’m feeling and sensing and picking up on where they’re at. I’m picking up on how my body is responding, and to me that’s informative and in some ways even diagnostic.

If I’m feeling a certain way, that can sometimes mean I’m taking on what they’re feeling. And sometimes I can use that to disburden them of what they’re holding onto because I have clearing practices and I can move the energy through me. Sometimes I just use it to understand what it feels like to be in their body right now. I find it has very little to do with me. Anyone who’s good at working with energy is good at opening up to become a portal or conduit to the healing energy that’s around us—energy that’s vast and powerful. It’s so beautiful. It’s so humbling.

Seeds of Change

When So-young learned that Paxil can cause weight gain, she wanted to be rid of it. Initially, as she slowly tapered off, So-young reported feeling a broader range of emotions, making her “feel more alive,” and she was captivated by this early, unexpected shift. Over the next few months, So-young also began to describe her marriage with a stronger sense of indignation, identifying her husband’s behavior as unacceptable and unlikely to change. … Though I felt concern about the tumult in her marriage, I generally saw the change in So-young as a positive sign of her wrestling with an authentic problem—primarily, that she’d been “asleep at the wheel” as she put it, often subduing her needs and making herself smaller in order to make room for her husband. As it dawned on So-young, however, that she had actually needed medication to tolerate her husband, she decided, with two young kids in the balance, to resume taking Paxil rather than face the tough road ahead. Still, the seed had been sown.

Excerpted from The Anatomy of Anxiety: Understanding and Overcoming the Body’s Fear Response by Ellen Vora, MD. Published by Harper Wave.

I remember early on in my experiences with ayahuasca, I felt these two grandmother-healer presences approach me and say, “Is it okay if we take over your body and heal with it?” And I’m like, “Yes! [Laughs] I’ll accept that.” And so, they let me have a practice with that. They said, “Okay, we’re going to have you move this way. We’re going to have you tilt this way. We’re going to have you say this or sound in this way. And that’s all it is. That’s what it feels like. Now bring this to your work.”

And now I can sometimes feel their presence in a treatment—and I feel they’re very gentle and sweet. They basically say, “Can we work through you right now?” And I always say, “Yes.” And then I feel like I have a way of switching, where I’m not actively driving the ship in that moment. I’m allowing something to take over. So that’s kind of how I experience witchcraft. Sometimes when I see a patient, I’ll get a little download: “Here’s what’s going on, and here’s what they need.” Then the art is in trying to bring that up in a way that someone can be receptive to, which isn’t always easy.

“Anyone who’s good at working with energy is good at opening up to become a portal or conduit to the healing energy that’s around us—energy that’s vast and powerful. It’s so beautiful. It’s so humbling.”

Let’s talk about meds. I recently interviewed Michael Pollan, and he says that much of the reason we drink coffee is to avoid the withdrawal symptoms from caffeine. From reading your book, it sounds like antidepressants can be a lot like coffee. They make you feel better for a bit, but then you’re taking them to avoid withdrawal.

What I find with my patients is that the real effect of antidepressants is to narrow the range of feeling. Your lows won’t be so low and your highs might not be so high—and that can look like real improvement when someone is so out of balance in their day-to-day lives that they cannot function. So, antidepressants can be a useful bridge. But they are not completely benign. I tend to believe that they patch us up, and then it’s in withdrawal that we really suffer.

When someone goes off meds and becomes `symptomatic, conventional doctors tend to call that relapse. But that is actually withdrawal. They say, “Look, you’ve stopped your meds and now you’re really depressed again. You should go back on your medication.” And the patient thinks, “Whoa, I’m so depressed again. That medicine really was working.” So, they go back on it and suddenly feel better, which further reinforces this idea that it really was working. So, yes, that’s much like drinking a cup of coffee on a caffeine-withdrawal headache. The antidote to its own withdrawal is a very rapid and convincing sense of relief. It gives a compelling feeling that that substance is good. But caffeine withdrawal means headaches and irritability and fatigue. Antidepressant withdrawal can be really dark and heavy. I loathe to set anybody up for that state, and that’s why I don’t think antidepressants are entirely benign.

I love it when a patient gets off antidepressants and it’s no big deal. To me that’s a success. But I can never predict who’s going to walk away from psych meds without a difficult withdrawal. It surprises me every time. For my patients for whom it’s really harrowing, I do try to leverage the experience to be meaningful. And in those moments, I really think of myself as midwifing a spiritual awakening.

Anatomy of anxiety scrabble

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