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

by Scott Stossel

  An influential study conducted a hundred years ago by two Harvard psychologists, Robert M. Yerkes and John Dillingham Dodson, demonstrated that moderate levels of anxiety improve performance in humans and animals: too much anxiety, obviously, and performance is impaired, but too little anxiety also impairs performance. When the use of antianxiety drugs exploded in the 1950s, some psychiatrists warned about the dangers presented by a society that was not anxious enough. “We then face the prospect of developing a falsely flaccid race of people which might not be too good for our future,” one wrote. Another psychiatrist averred that “Van Gogh, Isaac Newton: most of the geniuses and great creators were not tranquil. They were nervous, ego-driven men pushed on by a relentless inner force and beset by anxieties.”

  Is muting such genius a price society would have to pay for drastically reducing anxiety, pharmacologically or otherwise? And would that cost be worthwhile?

  “Without anxiety, little would be accomplished,” says David Barlow, the founder and director emeritus of the Center for Anxiety and Related Disorders at Boston University. “The performance of athletes, entertainers, executives, artisans, and students would suffer; creativity would diminish; crops might not be planted. And we would all achieve that idyllic state long sought after in our fast-paced society of whiling away our lives under a shade tree. This would be as deadly for the species as nuclear war.”

  I have come to believe that anxiety accompanies intellectual activity as its shadow and that the more we know of the nature of anxiety, the more we will know of intellect.

  —HOWARD LIDDELL, “THE ROLE OF VIGILANCE IN THE DEVELOPMENT OF ANIMAL NEUROSIS” (1949)

  Some eighty years ago, Freud proposed that anxiety was “a riddle whose solution would be bound to throw a flood of light on our whole mental existence.” Unlocking the mysteries of anxiety, he believed, would go far in helping us to unravel the mysteries of the mind: consciousness, the self, identity, intellect, imagination, creativity—not to mention pain, suffering, hope, and regret. To grapple with and understand anxiety is, in some sense, to grapple with and understand the human condition.

  The differences in how various cultures and eras have perceived and understood anxiety can tell us a lot about those cultures and eras. Why did the ancient Greeks of the Hippocratic school see anxiety mainly as a medical condition, while the Enlightenment philosophers saw it as an intellectual problem? Why did the early existentialists see anxiety as a spiritual condition, while Gilded Age doctors saw it as a specifically Anglo-Saxon stress response—a response that they believed spared Catholic societies—to the Industrial Revolution? Why did the early Freudians see anxiety as a psychological condition emanating from sexual inhibition, whereas our own age tends to see it, once again, as a medical and neurochemical condition, a problem of malfunctioning biomechanics?

  Do these shifting interpretations represent the forward march of progress and science? Or simply the changing, and often cyclical, ways in which cultures work? What does it say about the societies in question that Americans showing up in emergency rooms with panic attacks tend to believe they’re having heart attacks, whereas Japanese tend to be afraid they’re going to faint? Are the Iranians who complain of what they call “heart distress” suffering what Western psychiatrists would call panic attacks? Are the ataques de nervios experienced by South Americans simply panic attacks with a Latino inflection—or are they, as modern researchers now believe, a distinct cultural and medical syndrome? Why do drug treatments for anxiety that work so well on Americans and the French seem not to work effectively on the Chinese?

  As fascinating and multifarious as these cultural idiosyncrasies are, the underlying consistency of experience across time and cultures speaks to the universality of anxiety as a human trait. Even filtered through the distinctive cultural practices and beliefs of the Greenland Inuit a hundred years ago, the syndrome the Inuit called “kayak angst” (those afflicted by it were afraid to go out seal hunting alone) appears to be little different from what we today call agoraphobia. In Hippocrates’s ancient writings can be found clinical descriptions of pathological anxiety that sound quite modern. One of his patients was terrified of cats (simple phobia, which today would be coded 300.29 for insurance purposes, according to the classifications of the fifth edition of the Diagnostic and Statistical Manual, the DSM-V) and another of nightfall; a third, Hippocrates reported, was “beset by terror” whenever he heard a flute; a fourth could not walk alongside “even the shallowest ditch,” though he had no problem walking inside the ditch—evidence of what we would today call acrophobia, the fear of heights. Hippocrates also describes a patient suffering what would likely be called, in modern diagnostic terminology, panic disorder with agoraphobia (DSM-V code 300.22): the condition, as Hippocrates described it, “usually attacks abroad, if a person is travelling a lonely road somewhere, and fear seizes him.” The syndromes described by Hippocrates are recognizably the same clinical phenomena described in the latest issues of the Archives of General Psychiatry and Bulletin of the Menninger Clinic.

  Their similarities bridge the yawning gap of millennia and circumstances that separate them, providing a sense of how, for all the differences in culture and setting, the physiologically anxious aspects of human experience may be universal.

  In this book, I have set out to explore the “riddle” of anxiety. I am not a doctor, a psychologist, a sociologist, or a historian of science—any one of whom would bring more scholarly authority to a treatise on anxiety than I do. This is a work of synthesis and reportage, yoking together explorations of the idea of anxiety from history, literature, philosophy, religion, popular culture, and the latest scientific research—all of that woven through something about which I can, alas, claim extensive expertise: my own experience with anxiety. Examining the depths of my own neuroses may seem the height of narcissism (and studies do show that self-preoccupation tends to be tied to anxiety), but it’s an exercise with worthy antecedents. In 1621, the Oxford scholar Robert Burton published his canonical The Anatomy of Melancholy, a staggering thirteen-hundred-page work of synthesis, whose torrents of scholarly exegesis only partially obscure what it really is: a massive litany of anxious, depressive complaint. In 1733, George Cheyne, a prominent London physician and one of the most influential psychological thinkers of the eighteenth century, published The English Malady, which includes the forty-page chapter “The Case of the Author” (dedicated to “my fellow sufferers”), in which he reports in minute detail on his neuroses (including “Fright, Anxiety, Dread, and Terror” and “a melancholy Fright and Panick, where my Reason was of no Use to me”) and physical symptoms (including “a sudden violent Head-ach,” “extream Sickness in my Stomach,” and “a constant Colick, and an ill Taste and Savour in my Mouth”) over the years. More recently, the intellectual odysseys of Charles Darwin, Sigmund Freud, and William James were powerfully driven by their curiosity about, and the desire to find relief from, their own anxious suffering. Freud used his acute train phobia and his hypochondria, among other things, to construct his theory of psychoanalysis; Darwin was effectively housebound by stress-related illnesses after the voyage of the Beagle—he spent years in pursuit of relief from his anxiety, visiting spas and, on the advice of one doctor, encasing himself in ice. James tried to keep his phobias hidden from the public but was often quietly terrified. “I awoke morning after morning with a horrible dread in the pit of my stomach and with a sense of insecurity of life that I never knew before,” he wrote in 1902 of the onset of his anxiety. “For months, I was unable to go out in the dark alone.”

  Unlike Darwin, Freud, and James, I’m not out to adumbrate a whole new theory of mind or of human nature. Rather, this book is motivated by a quest to understand, and to find relief from or redemption in, anxious suffering. This quest has taken me both backward, into history, and forward, to the frontiers of modern scientific research. I have spent much of the past eight years reading through hundreds of thousands of the pages that have been writ
ten about anxiety over the last three thousand years.

  My life has, thankfully, lacked great tragedy or melodrama. I haven’t served any jail time. I haven’t been to rehab. I haven’t assaulted anyone or carried out a suicide attempt. I haven’t woken up naked in the middle of a field, sojourned in a crack house, or been fired from a job for erratic behavior. As psychopathologies go, mine has been—so far, most of the time, to outward appearances—quiet. Robert Downey Jr. will not be starring in the movie of my life. I am, as they say in the clinical literature, “high functioning” for someone with an anxiety disorder or a mental illness; I’m usually quite good at hiding it. More than a few people, some of whom think they know me quite well, have remarked that they are struck that I, who can seem so even-keeled and imperturbable, would choose to write a book about anxiety. I smile gently while churning inside and thinking about what I’ve learned is a signature characteristic of the phobic personality: “the need and ability”—as described in the self-help book Your Phobia—“to present a relatively placid, untroubled appearance to others, while suffering extreme distress on the inside.”c

  To some people, I may seem calm. But if you could peer beneath the surface, you would see that I’m like a duck—paddling, paddling, paddling.

  The chief patient I am preoccupied with is myself.

  —SIGMUND FREUD TO WILHELM FLIESS (AUGUST 1897)

  It has occurred to me that writing this book might be a terrible idea: if it’s relief from nervous suffering that I crave, then burrowing into the history and science of anxiety, and into my own psyche, is perhaps not the best way to achieve it.

  In my travels through the historical literature on anxiety, I came across a little self-help book by a British army veteran named Wilfrid Northfield, who suffered nervous prostration during the First World War and then spent ten years largely incapacitated by anxiety before successfully convalescing and writing his guide to recovery. Published in 1933, Conquest of Nerves: The Inspiring Record of a Personal Triumph over Neurasthenia, became a best seller; the copy I have is from the sixth printing, in 1934. In his last chapter, “A Few Final Words,” Northfield writes: “There is one thing the neurasthenic must guard against very strongly, and that is talking about his troubles. He can get no comfort or assistance in so doing.” Northfield goes on: “To talk of troubles in a voluble, despairing way, merely piles on the agony and ‘plays-up’ the emotions. Not only so, but it is selfish.” Citing another author, he concludes: “ ‘Never display a wound, except to a physician.”

  Never display a wound. Well, after more than thirty years of endeavoring—successfully much of the time—to conceal my anxiety from people, here I am putting it on protracted exhibition for acquaintances and strangers alike. If Northfield is correct (and my worried mother agrees with him), this project can hardly be auspicious for my mental health. Elements of modern research lend support to Northfield’s warning: anxious people have a pathological tendency to focus their attention inward, on themselves, in a way that suggests a book-length dwelling on one’s own anxiety is hardly the best way to escape it.d

  Moreover, one concern I’ve had about writing this book is that I’ve subsisted professionally on my ability to project calmness and control; my anxiety makes me conscientious (I’m afraid of screwing things up), and my shame can make me seem poised (I need to hide that I’m anxious). A former colleague once described me as “human Xanax,” telling me, as I chuckled inwardly, that I project such equanimity that my mere presence can be calming to others: simply to walk into a room full of agitated people is to administer my soothing balm; people relax in my wake. If only she knew! By revealing the fraudulence of my putative calm, am I forfeiting my ability to soothe others and thereby compromising my professional standing?

  My current therapist, Dr. W., says there is always the possibility that revealing my anxiety will lift the burden of shame and reduce the isolation of solitary suffering. When I get skittish about airing my psychiatric issues in a book, Dr. W. says: “You’ve been keeping your anxiety a secret for years, right? How’s that working out for you?”

  Point taken. And there is a rich and convincing literature about how—contrary to the admonitions of Wilfrid Northfield (and my mother)—hiding or suppressing anxiety actually produces more anxiety.e But there is no escaping my concern that this exercise is not only self-absorbed and shameful but risky—that it will prove the Wile E. Coyote moment when I look down to discover that, instead of inner strengths or outer buttresses to support me, there is in fact nothing to stop me from falling a long way down.

  I know how indecent and shocking Egotism is, and for an Author to make himself the Subject of his Words or Works, especially in so tedious and circumstantiated a Detail: But … I thought … perhaps it may not be quite useless to some low desponding valetudinary, over-grown Person, whose Case may have some Resemblance to mine.

  —GEORGE CHEYNE, The English Malady (1733)

  “Why,” Dr. W. asks, “do you think writing about your anxiety in a book would be so shameful?”

  Because stigma still attaches to mental illness. Because anxiety is seen as weakness. Because, as the signs posted on Allied gun installations in Malta during World War II so bluntly put it, “if you are a man you will not permit your self-respect to admit an anxiety neurosis or to show fear.” Because I worry that this book, with its revelations of anxiety and struggle, will be a litany of Too Much Information, a violation of basic standards of restraint and decorum.f

  When I explain this to Dr. W., he says that the very act of working on this book, and of publishing it, could be therapeutic. In presenting my anxiety to the world, he says, I will be “coming out.” The implication is that this will be liberating, as though I were gay and coming out of the closet. But being gay—we now finally know (homosexuality was classified as a mental disorder by the American Psychiatric Association until 1973)—is not a weakness or a defect or an illness. Being excessively nervous is.

  For a long time, governed by reticence and shame, I had told people who inquired about my book that it was “a cultural and intellectual history of anxiety”—true, as far as it goes—without revealing its personal aspects. But a little while ago, in an effort to test the effects of “coming out” as anxious, I began gingerly to speak more forthrightly about what the book was about: “a cultural and intellectual history of anxiety, woven together by my own experiences with anxiety.”

  The effect was striking. When I had spoken about the book as arid history, people would nod politely, and a few would buttonhole me privately later to ask me specific questions about this or that aspect of anxiety. But as I started to acknowledge the personal parts of the book, I found myself surrounded by avid listeners, eager to tell me about their own, or their family members’, anxiety.

  One night I attended a dinner with a bunch of writers and artists. Someone asked what I was working on, and I delivered my new spiel (“a cultural and intellectual history of anxiety, woven together and animated by my own experiences with anxiety”), talking about some of my experiences with various antianxiety and antidepressant medications. To my astonishment, each of the other nine people within earshot responded by telling me a story about his or her own experience with anxiety and medication.g Around the table we went, sharing our tales of neurotic woe.h

  I was struck that admitting my own anxiety over dinner had dislodged such an avalanche of personal confessions of anxiety and pharmacotherapy. Granted, I was with a bunch of writers and artists, a population ostensibly more prone, as observers since Aristotle have noted, to various forms of mental illness than other people. So maybe these stories simply provide evidence that writers are crazy. Or maybe the stories are evidence that the pharmaceutical companies have succeeded in medicalizing a normal human experience and marketing drugs to “treat” it.i But maybe more people than I thought are struggling with anxiety.

  “Yes!” said Dr. W. when I ventured this proposition at my next session with him. Then he told me a story of h
is own: “My brother used to host regular salon evenings, where people would be invited in to lecture on various topics. I was asked to give a talk on phobias. After my lecture, every single one of the people there came up to tell me about their phobias. I think the official numbers, as high as they are, underreport.”

  After he told me this, I thought about Ben, my best friend from college, a rich and successful writer (he regularly graces the best-seller lists and box-office charts), whose doctor had recently prescribed him Ativan, a benzodiazepine, to combat the anxious tightness in his chest that had him convinced he was suffering a heart attack.j And I thought of Ben’s neighbor M., a multimillionaire hedge fund manager, who takes Xanax constantly for his panic attacks. And of my former colleague G., an eminent political journalist, who in the years since ending up in an emergency room after a panic episode has been taking various benzodiazepines to prevent further attacks. And of another former colleague, B., whose anxiety left him stammering in meetings and unable to complete work projects until he went on Lexapro.

  No, not everyone gets overwhelmed by anxiety. My wife, for one, does not. (Thank God.) Barack Obama, by all accounts, does not. Nor, evidently, does David Petraeus, the former commander of U.S. forces in Afghanistan and former director of the CIA: he once told a reporter that despite being in jobs where the day-to-day stakes are a matter of life and death, he “rarely feels stress at all.”k All-Pro quarterbacks like Tom Brady and Peyton Manning manifestly do not, at least not on the field.l One of the things I explore in this book is why some people are preternaturally calm, exhibiting grace even under tremendous pressure, while others of us succumb to panic at the mildest hint of stress.

  Yet enough of us do suffer from anxiety that perhaps writing about my own ought not to be an occasion for shame but an opportunity to provide solace to some of the millions of others who share this affliction. And maybe, as Dr. W. often reminds me, the exercise will be therapeutic. “You can write yourself to health,” he says.