My Age of Anxiety: Fear, Hope, Dread, and the Search for Peace of Mind

by Scott Stossel

  THIS IS A BORZOI BOOK

  PUBLISHED BY ALFRED A. KNOPF

  Copyright © 2013 by Scott Stossel

  All rights reserved.

  Published in the United States by Alfred A. Knopf, a division of Random House LLC, New York, and in Canada by Random House of Canada Limited, Toronto, Penguin Random House Companies.

  www.aaknopf.com

  Knopf, Borzoi Books, and the colophon are registered trademarks of Random House LLC.

  Library of Congress Cataloging-in-Publication Data

  Stossel, Scott.

  My age of anxiety: fear, hope, dread, and the search for peace of mind / Scott Stossel.—First edition.

  pages cm

  Includes bibliographical references.

  ISBN 978-0-307-26987-4 (hardcover)

  eBook ISBN: 978-0-385-35132-4

  1. Anxiety. 2. Anxiety—Chemotherapy. 3. Anxiety disorders—Epidemiology. 4. Tranquilizing drugs—Social aspects.

  5. Stossel, Scott—Mental health. I. Title.

  RC531.S78 2014

  616.85’22—dc23 2013006336

  Jacket design by Carol Carson

  v3.1

  For Maren and Nathaniel—

  may you be spared.

  Contents

  Cover

  Title Page

  Copyright

  Dedication

  PART I

  The Riddle of Anxiety

  ONE The Nature of Anxiety

  TWO What Do We Talk About When We Talk About Anxiety?

  PART II

  A History of My Nervous Stomach

  THREE A Rumbling in the Belly

  FOUR Performance Anxiety

  PART III

  Drugs

  FIVE “A Sack of Enzymes”

  SIX A Brief History of Panic; or, How Drugs Created a New Disorder

  SEVEN Medication and the Meaning of Anxiety

  PART IV

  Nurture Versus Nature

  EIGHT Separation Anxiety

  NINE Worriers and Warriors: The Genetics of Anxiety

  TEN Ages of Anxiety

  PART V

  Redemption and Resilience

  ELEVEN Redemption

  TWELVE Resilience

  Acknowledgments

  Notes

  Bibliography

  A Note About the Author

  Other Books by This Author

  PART I

  The Riddle of Anxiety

  CHAPTER 1

  The Nature of Anxiety

  And no Grand Inquisitor has in readiness such terrible tortures as has anxiety, and no spy knows how to attack more artfully the man he suspects, choosing the instant when he is weakest, nor knows how to lay traps where he will be caught and ensnared, as anxiety knows how, and no sharpwitted judge knows how to interrogate, to examine the accused as anxiety does, which never lets him escape, neither by diversion nor by noise, neither at work nor at play, neither by day nor by night.

  —SØREN KIERKEGAARD, The Concept of Anxiety (1844)

  There is no question that the problem of anxiety is a nodal point at which the most various and important questions converge, a riddle whose solution would be bound to throw a flood of light on our whole mental existence.

  —SIGMUND FREUD,

  Introductory Lectures on Psycho-Analysis (1933)

  I have an unfortunate tendency to falter at crucial moments.

  For instance, standing at the altar in a church in Vermont, waiting for my wife-to-be to come down the aisle to marry me, I start to feel horribly ill. Not just vaguely queasy, but severely nauseated and shaky—and, most of all, sweaty. The church is hot that day—it’s early July—and many people are perspiring in their summer suits and sundresses. But not like I am. As the processional plays, sweat begins to bead on my forehead and above my upper lip. In wedding photos, you can see me standing tensely at the altar, a grim half smile on my face, as I watch my fiancée come down the aisle on the arm of her father: in the photos, Susanna is glowing; I am glistening. By the time she joins me in the front of the church, rivulets of sweat are running into my eyes and dripping down my collar. We turn to face the minister. Behind him are the friends we have asked to give readings, and I see them looking at me with manifest concern. What’s wrong with him? I imagine they are thinking. Is he going to pass out? Merely imagining these thoughts makes me sweat even more. My best man, standing a few feet behind me, taps me on the shoulder and hands me a tissue to mop my brow. My friend Cathy, sitting many rows back in the church, will tell me later that she had a strong urge to bring me a glass of water; it looked, she said, as if I had just run a marathon.

  The wedding readers’ facial expressions have gone from registering mild concern to what appears to me to be unconcealed horror: Is he going to die? I’m beginning to wonder that myself. For I have started to shake. I don’t mean slight trembling, the sort of subtle tremor that would be evident only if I were holding a piece of paper—I feel like I’m on the verge of convulsing. I am concentrating on keeping my legs from flying out from under me like an epileptic’s and am hoping that my pants are baggy enough to keep the trembling from being too visible. I’m now leaning on my almost wife—there is no hiding the trembling from her—and she is doing her best to hold me up.

  The minister is droning on; I have no idea what he’s saying. (I am not, as they say, present in the moment.) I’m praying for him to hurry up so I can escape this torment. He pauses and looks down at my betrothed and me. Seeing me—the sheen of flop sweat, the panic in my eyes—he is alarmed. “Are you okay?” he mouths silently. Helplessly, I nod that I am. (Because what would he do if I said that I wasn’t? Clear the church? The mortification would be unbearable.)

  As the minister resumes his sermon, here are three things I am actively fighting: the shaking of my limbs; the urge to vomit; and unconsciousness. And this is what I am thinking: Get me out of here. Why? Because there are nearly three hundred people—friends and family and colleagues—watching us get married, and I am about to collapse. I have lost control of my body. This is supposed to be one of the happiest, most significant moments of my life, and I am miserable. I worry I will not survive.

  As I sweat and swoon and shake, struggling to carry out the wedding ritual (saying “I do,” putting the rings on, kissing the bride), I am worrying wretchedly about what everyone (my wife’s parents, her friends, my colleagues) must be thinking as they look at me: Is he having second thoughts about getting married? Is this evidence of his essential weakness? His cowardice? His spousal unsuitability? Any doubt that any friend of my wife’s had, I fear, is being confirmed. I knew it, I imagine those friends thinking. This proves he’s not worthy of marrying her. I look as though I’ve taken a shower with my clothes on. My sweat glands—my physical frailty, my weak moral fiber—have been revealed to the world. The unworthiness of my very existence has been exposed.

  Mercifully, the ceremony ends. Drenched in sweat, I walk down the aisle, clinging gratefully to my new wife, and when we get outside the church, the acute physical symptoms recede. I’m not going to have convulsions. I’m not going to pass out. But as I stand in the reception line, and then drink and dance at the reception, I’m pantomiming happiness. I’m smiling for the camera, shaking hands—and wanting to die. And why not? I have failed at one of the most elemental of male jobs: getting married. How have I managed to cock this up, too? For the next seventy-two hours, I endure a brutal, self-lacerating despair.

  Anxiety kills relatively few people, but many more would welcome death as an alternative to the paralysis and suffering r
esulting from anxiety in its severe forms.

  —DAVID H. BARLOW, Anxiety and Its Disorders (2004)

  My wedding was not the first time I’d broken down, nor was it the last. At the birth of our first child, the nurses had to briefly stop ministering to my wife, who was in the throes of labor, to attend to me as I turned pale and keeled over. I’ve frozen, mortifyingly, onstage at public lectures and presentations, and on several occasions I have been compelled to run offstage. I’ve abandoned dates, walked out of exams, and had breakdowns during job interviews, on plane flights, train trips, and car rides, and simply walking down the street. On ordinary days, doing ordinary things—reading a book, lying in bed, talking on the phone, sitting in a meeting, playing tennis—I have thousands of times been stricken by a pervasive sense of existential dread and been beset by nausea, vertigo, shaking, and a panoply of other physical symptoms. In these instances, I have sometimes been convinced that death, or something somehow worse, was imminent.

  Even when not actively afflicted by such acute episodes, I am buffeted by worry: about my health and my family members’ health; about finances; about work; about the rattle in my car and the dripping in my basement; about the encroachment of old age and the inevitability of death; about everything and nothing. Sometimes this worry gets transmuted into low-grade physical discomfort—stomachaches, headaches, dizziness, pains in my arms and legs—or a general malaise, as though I have mononucleosis or the flu. At various times, I have developed anxiety-induced difficulties breathing, swallowing, even walking; these difficulties then become obsessions, consuming all of my thinking.

  I also suffer from a number of specific fears or phobias. To name a few: enclosed spaces (claustrophobia); heights (acrophobia); fainting (asthenophobia); being trapped far from home (a species of agoraphobia); germs (bacillophobia); cheese (turophobia); speaking in public (a subcategory of social phobia); flying (aerophobia); vomiting (emetophobia); and, naturally, vomiting on airplanes (aeronausiphobia).

  When I was a child and my mother was attending law school at night, I spent evenings at home with a babysitter, abjectly terrified that my parents had died in a car crash or had abandoned me (the clinical term for this is “separation anxiety”); by age seven I had worn grooves in the carpet of my bedroom with my relentless pacing, trying to will my parents to come home. During first grade, I spent nearly every afternoon for months in the school nurse’s office, sick with psychosomatic headaches, begging to go home; by third grade, stomachaches had replaced headaches, but my daily trudge to the infirmary remained the same. During high school, I would purposely lose tennis and squash matches to escape the agony of anxiety that competitive situations would provoke in me. On the one—the only one—date I had in high school, when the young lady leaned in for a kiss during a romantic moment (we were outside, gazing at constellations through her telescope), I was overcome by anxiety and had to pull away for fear that I would vomit. My embarrassment was such that I stopped returning her phone calls.

  In short, I have since the age of about two been a twitchy bundle of phobias, fears, and neuroses. And I have, since the age of ten, when I was first taken to a mental hospital for evaluation and then referred to a psychiatrist for treatment, tried in various ways to overcome my anxiety.

  Here’s what I’ve tried: individual psychotherapy (three decades of it), family therapy, group therapy, cognitive-behavioral therapy (CBT), rational emotive therapy (RET), acceptance and commitment therapy (ACT), hypnosis, meditation, role-playing, interoceptive exposure therapy, in vivo exposure therapy, supportive-expressive therapy, eye movement desensitization and reprocessing (EMDR), self-help workbooks, massage therapy, prayer, acupuncture, yoga, Stoic philosophy, and audiotapes I ordered off a late-night TV infomercial.

  And medication. Lots of medication. Thorazine. Imipramine. Desipramine. Chlorpheniramine. Nardil. BuSpar. Prozac. Zoloft. Paxil. Wellbutrin. Effexor. Celexa. Lexapro. Cymbalta. Luvox. Trazodone. Levoxyl. Propranolol. Tranxene. Serax. Centrax. St. John’s wort. Zolpidem. Valium. Librium. Ativan. Xanax. Klonopin.

  Also: beer, wine, gin, bourbon, vodka, and scotch.

  Here’s what’s worked: nothing.

  Actually, that’s not entirely true. Some drugs have helped a little, for finite periods of time. Thorazine (an antipsychotic, which used to be classified as a major sedative) and imipramine (a tricyclic antidepressant) combined to help keep me out of the psychiatric hospital in the early 1980s, when I was in middle school and ravaged by anxiety. Desipramine, another tricyclic, got me through my early twenties. Paxil (a selective serotonin reuptake inhibitor, or SSRI) gave me about six months of significantly reduced anxiety in my late twenties before the fear broke through again. Ample quantities of Xanax, propranolol, and vodka got me (barely) through a book tour and various public lectures and TV appearances in my early thirties. A double scotch plus a Xanax and a Dramamine can sometimes, when administered before takeoff, make flying tolerable—and two double scotches, when administered in quick enough succession, can obscure existential dread, making it seem fuzzier and further away.

  But none of these treatments have fundamentally reduced the underlying anxiety that seems woven into my soul and hardwired into my body and that at times makes my life a misery. As the years pass, the hope of being cured of my anxiety has faded into a resigned desire to come to terms with it, to find some redemptive quality or mitigating benefit to my being, too often, a quivering, quaking, neurotic wreck.

  Anxiety is the most prominent mental characteristic of Occidental civilization.

  —R. R. WILLOUGHBY, Magic and Cognate Phenomena (1935)

  Anxiety and its associated disorders represent the most common form of officially classified mental illness in the United States today, more common even than depression and other mood disorders. According to the National Institute of Mental Health, some forty million Americans, nearly one in seven of us, are suffering from some kind of anxiety disorder at any given time, accounting for 31 percent of the expenditures on mental health care in the United States. According to recent epidemiological data, the “lifetime incidence” of anxiety disorder is more than 25 percent—which, if true, means that one in four of us can expect to be stricken by debilitating anxiety at some point in our lifetimes. And it is debilitating: Recent academic papers have argued that the psychic and physical impairment tied to living with an anxiety disorder is equivalent to living with diabetes—usually manageable, sometimes fatal, and always a pain to deal with. A study published in The American Journal of Psychiatry in 2006 found that Americans lose a collective 321 million days of work because of anxiety and depression each year, costing the economy $50 billion annually; a 2001 paper published by the U.S. Bureau of Labor Statistics once estimated that the median number of days missed each year by American workers who suffer from anxiety or stress disorders is twenty-five. In 2005—three years before the recent economic crisis hit—Americans filled fifty-three million prescriptions for just two antianxiety drugs: Ativan and Xanax. (In the weeks after 9/11, Xanax prescriptions jumped 9 percent nationally—and by 22 percent in New York City.) In September 2008, the economic crash caused prescriptions in New York City to spike: as banks went belly up and the stock market went into free fall, prescriptions for anti-depressant and antianxiety medications increased 9 percent over the year before, while prescriptions for sleeping pills increased 11 percent.

  Though some have argued that anxiety is a particularly American affliction, it’s not just Americans who suffer from it. A report published in 2009 by the Mental Health Foundation in England found that fifteen percent of people living in the United Kingdom are currently suffering from an anxiety disorder and that rates are increasing: 37 percent of British people report feeling more frightened than they used to. A recent paper in The Journal of the American Medical Association observed that clinical anxiety is the most common emotional disorder in many countries. A comprehensive global review of anxiety studies published in 2006 in The Canadian Journal of Psychiatry conc
luded that as many as one in six people worldwide will be afflicted with an anxiety disorder for at least a year during some point in their lifetimes; other studies have reported similar findings.

  Of course, these figures refer only to people, like me, who are, according to the somewhat arbitrary diagnostic criteria established by the American Psychiatric Association, technically classifiable as clinically anxious. But anxiety extends far beyond the population of the officially mentally ill. Primary care physicians report that anxiety is one of the most frequent complaints driving patients to their offices—more frequent, by some accounts, than the common cold. One large-scale study from 1985 found that anxiety prompted more than 11 percent of all visits to family doctors; a study the following year reported that as many as one in three patients complained to their family physicians of “severe anxiety.” (Other studies have reported that 20 percent of primary care patients in America are taking a benzodiazepine such as Valium or Xanax.) And almost everyone alive has at some point experienced the torments of anxiety—or of fear or of stress or of worry, which are distinct but related phenomena. (Those who are unable to experience anxiety are, generally speaking, more deeply pathological—and more dangerous to society—than those who experience it acutely or irrationally; they’re sociopaths.)

  Few people today would dispute that chronic stress is a hallmark of our times or that anxiety has become a kind of cultural condition of modernity. We live, as has been said many times since the dawn of the atomic era, in an age of anxiety—and that, cliché though it may be, seems only to have become more true in recent years as America has been assaulted in short order by terrorism, economic calamity and disruption, and widespread social transformation.

  And yet, as recently as thirty years ago, anxiety per se did not exist as a clinical category. In 1950, when the psychoanalyst Rollo May published The Meaning of Anxiety, he observed that at that point only two others, Søren Kierkegaard and Sigmund Freud, had undertaken book-length treatments of the idea of anxiety. In 1927, according to the listing in Psychological Abstracts, only three academic papers on anxiety were published; in 1941, there were only fourteen; and as late as 1950, there were only thirty-seven. The first-ever academic conference dedicated solely to the topic of anxiety didn’t take place until June 1949. Only in 1980—after new drugs designed to treat anxiety had been developed and brought to market—were the anxiety disorders finally introduced into the third edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, displacing the Freudian neuroses. In an important sense, the treatment predated the diagnosis—that is, the discovery of antianxiety drugs drove the creation of anxiety as a diagnostic category.