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

by Scott Stossel

  Beaumont noticed that St. Martin’s emotional states had a powerful effect on his stomach, one readily observable to the naked eye: the mucosal lining of the hunter’s stomach would change color dramatically, like a mood ring, in tandem with his emotional states. Sometimes the stomach lining was bright red; at other times, such as when St. Martin was anxious, it turned pale.

  “I have availed myself of the opportunity afforded by an occurrence of circumstances which can probably never occur again,” Beaumont wrote. But he was wrong. Medical literature records at least two subsequent instances of digestion research conducted on patients with holes in their stomachs over the course of the next century. And then, in 1941, Stewart Wolf and Harold Wolff, physicians at New York Hospital in Manhattan, discovered Tom.

  One day in 1904, when Tom was nine years old, he took a swig of what he thought was beer (it was in his father’s beer pail) but turned out to be boiling hot clam chowder. The chowder seared his upper digestive tract and knocked him unconscious. By the time his mother delivered him to the hospital, his esophagus had fused shut. For the rest of his life, the only way for him to receive nourishment was through a surgically opened hole in the stomach wall. The hole was ringed on the outside by a segment of his stomach lining. He fed himself by chewing his food and then inserting it directly into his stomach through a funnel placed in the hole in his abdomen.

  Tom came to the attention of Drs. Wolf and Wolff in 1941, when, while working as a sewer laborer, he was compelled to seek medical assistance after his wound became irritated. Recognizing the unusual research opportunity represented by Tom’s condition, the doctors hired him as a lab assistant and conducted multiple experiments on him over the course of seven months. The results were published in their 1943 book, Human Gastric Function, a landmark of psychosomatic research.

  Building on Beaumont’s findings, the doctors observed that the lining of Tom’s stomach varied significantly in color based on its level of activity—from “faint yellowish red to a deep cardinal shade.” Greater levels of digestive activity tended to correlate with deeper shades of red (suggesting increased blood flow to the stomach), while lesser levels, including those induced by anxiety, correlated with paler colors (suggesting the flow of blood away from the stomach).

  The doctors were able to chart correlations that had long been assumed but were never scientifically proved. One afternoon another doctor barged into the lab, swearing to himself and rapidly opening and closing drawers, looking for documents that had been mislaid. Tom, whose job it was to keep the lab tidy, became alarmed—he feared he would lose his job. The lining of his stomach went instantly pale, dropping from “90 percent redness” on the color scale to 20 percent. Acid secretion nearly stopped. When the doctor found the missing papers a few minutes later, acid secretion resumed and the color gradually returned to Tom’s stomach.

  At some level, all this is unsurprising; everyone knows that anxiety can cause gastrointestinal distress. (My friend Anne says that the most effective weight-loss program she ever tried was the Stressful Divorce Diet.) But Human Gastric Function represented the first time that the connections had been charted in such precise and systematic detail. The relationship between Tom’s mental state and his digestion was not vague and diffuse; his stomach was a concrete and direct register of his psychology. Summing up their observations, Wolf and Wolff concluded that there was a strong inverse correlation between what they called “emotional security” and stomach discomfort.

  That’s certainly true in my case. Being anxious makes my stomach hurt and my bowels loosen. My stomach hurting and my bowels loosening makes me more anxious, which makes my stomach hurt more and my bowels even looser, and so nearly every trip of any significant distance from home ends up the same way: with me scurrying frantically from restroom to restroom on a kind of grand tour of the local latrines. For instance, I don’t have terribly vivid recollections of the Vatican or the Colosseum or the Italian rail system. I do, however, have searing memories of the public restrooms in the Vatican and at the Colosseum and in various Italian train stations. One day, I visited the Trevi Fountain—or, rather, my wife and her family visited the Trevi Fountain. I visited the restroom of a nearby gelateria, where a series of impatient Italians banged on the door while I bivouacked there. The next day, when the family drove to Pompeii, I gave up and stayed in bed, a reassuringly short distance from the bathroom.

  Some years earlier, following the fall of the Berlin Wall and the dissolution of the Warsaw Pact, I traveled to Eastern Europe to visit a girlfriend, Ann, who was studying in Poland. She had been there for six months by the time I visited; I had planned and aborted (because of anxiety) several previous trips, and only the fear that Ann would finally break up with me if I didn’t visit her impelled me to fight through my tremendous dread of a transatlantic flight to meet her in Warsaw. Drugged to near unconsciousness, I flew from Boston to London and then to Warsaw. Befogged by sedatives, antiemetic medications, and jet lag, I stumbled through our first day and a half together. My bowels percolated to life about the time the rest of me did, when the Dramamine and Xanax wore off. We ended up traipsing around Eastern Europe from restroom to restroom. This was frustrating for her and harrowing for me—because, among other reasons, many Eastern European public commodes were at that time rather primitive; you often had to pay an attendant in advance on a per sheet basis for scratchy, ill-constructed toilet paper. By the end of the trip, I’d given up; Ann went sightseeing while I retreated to our hotel room, where at least I didn’t have to gauge my toilet tissue use in advance.

  Ann, understandably, grew peevish about this. After visiting the home of Franz Kafka (who, I note, suffered from chronic bowel trouble), we walked across Wenceslas Square in Prague while I griped about my aching belly. Ann could no longer contain her exasperation. “Maybe you should write a dissertation about your stomach,” she said, mocking my preoccupation. A preoccupation, you may have noticed, that I have yet to overcome.

  But when your stomach governs your existence, it’s hard not to be preoccupied with it. A few searing experiences—soiling yourself on an airplane, say, or on a date—will focus you passionately on your gastrointestinal tract. You need to devote effort to planning around it—because it will not always plan around you.

  Case in point: Fifteen years ago, while researching my first book, I spent part of the summer living with the extended Kennedy family on Cape Cod. One weekend, then–president Bill Clinton, who was vacationing on Martha’s Vineyard, came across Nantucket Sound to go sailing with Ted Kennedy. Hyannis Port, where the Kennedys have their vacation homes, was crawling with presidential aides and Secret Service agents. With some time to kill before dinner, I decided to walk around town to take in the scene.

  Bad idea. As is so often the case with irritable bowel syndrome, it was at precisely the moment I passed beyond Easily Accessible Bathroom Range that my clogged plumbing came unglued. Sprinting back to the house where I was staying, I was several times convinced I would not make it and—teeth gritted, sweating voluminously—was reduced to evaluating various bushes and storage sheds along the way for their potential as ersatz outhouses. Imagining what might ensue if a Secret Service agent were to happen upon me crouched in the shrubbery lent a kind of panicked, otherworldly strength to my efforts at self-possession.

  As I approached the entrance, I was simultaneously reviewing the floor plan in my head (Which of the many bathrooms in the mansion is closest to the front door? Can I make it all the way upstairs to my room?) and praying that I wouldn’t be fatally waylaid by a stray Kennedy or celebrity (Arnold Schwarzenegger, Liza Minnelli, and the secretary of the navy, among others, were visiting that weekend).

  Fortunately, I made it into the house unaccosted. Then a quick calculation: Can I make it all the way upstairs and down the hall to my suite in time? Or should I duck into the bathroom in the front hall? Hearing footsteps above and fearing a protracted encounter, I opted for the latter and slipped into the bathroom, wh
ich was separated from the front hall by an anteroom and two separate doors. I scampered through the anteroom and flung myself onto the toilet.

  My relief was extravagant and almost metaphysical.

  But then I flushed and … something happened. My feet were getting wet. I looked down and saw to my horror that water was flowing out from the base of the toilet. Something seemed to have exploded. The floor—along with my shoes and pants and underwear—was covered in sewage. The water level was rising.

  Instinctively, I stood up and turned around. Could the flooding be stopped? I removed the porcelain top of the toilet tank, scattering the flowers and potpourri that sat atop it, and frantically began fiddling with its innards. I tried things blindly, raising this and lowering that, jiggling this and wiggling that, fishing around in the water for something that might stem the swelling tide.

  Somehow, whether of its own accord or as a result of my haphazard fiddling, the flooding slowed and then stopped. I surveyed the scene. My clothes were drenched and soiled. So was the bathroom rug. Without thinking, I slipped out of my pants and boxer shorts, wrapped them in the waterlogged rug, and jammed the whole mess into the wastebasket, which I stashed in the cupboard under the sink. Have to deal with this later, I thought to myself.

  It was at this unpropitious moment that the dinner bell rang, signaling that it was time to muster for cocktails in the living room.

  Which was right across the hall from the bathroom.

  Where I was standing ankle-deep in sewage.

  I pulled all the hand towels off the wall and dropped them on the ground to start sopping up some of the toilet water. I got down on my hands and knees and, unraveling the whole roll of toilet paper, began dabbing frenziedly at the water around me. It was like trying to dry a lake with a kitchen sponge.

  What I was feeling at that point was not, strictly speaking, anxiety; rather, it was a resigned sense that the jig was up, that my humiliation would be complete and total. I’d soiled myself, destroyed the estate’s septic system, and might soon be standing half naked before God knows how many members of the political and Hollywood elite.

  In the distance, voices were moving closer. It occurred to me that I had two choices. I could hunker down in the bathroom, hiding and waiting out the cocktail party and dinner—at the risk of having to fend off anyone who might start banging on the door—and use the time to try to clean up the wreckage before slipping up to my bedroom after everyone had gone to bed. Or I could try to make a break for it.

  I took all of the soiled towels and toilet paper and shoved them into the cupboard, then set about preparing my escape. I retrieved the least soiled towel (which was nonetheless dirty and sodden) and wrapped it gingerly around my waist. I crept to the door and listened for voices and footsteps, trying to gauge distance and speed of approach. Knowing I had scarcely any time before everyone converged on the center of the house, I slipped out the bathroom door and through the anteroom, sprint-walked across the hallway, and darted up the stairs. I hit the first landing, made a hairpin turn, and headed up the next flight to the second floor—where I nearly ran headlong into John F. Kennedy Jr. and another man.

  “Hi, Scott,” Kennedy said.a

  “Uh, hi,” I said, racking my brain for a plausible explanation for why I might be running through the house at cocktail hour with no pants on, drenched in sweat, swaddled in a soiled and reeking towel. But he and his friend appeared utterly unfazed—as though half-naked houseguests covered in their own excrement were frequent occurrences here—and walked past me down the stairs.

  I scrambled down the hallway to my room, where I showered vigorously, changed, and generally tried to compose myself as best I could—which was not easy because I was continuing to sweat terribly, right through my blazer, the result of anxiety, exertion, and summer humidity.

  If someone had snapped a photo of the scene at cocktails that evening, here’s what it would show: various celebrities and politicians and priests all glowing with grace and easy bonhomie as they mingle effortlessly on the veranda overlooking the Atlantic—while, just off to the side, a sweaty young writer stands awkwardly gulping gin and tonics and thinking about how far he is from fitting in with this illustrious crowd and about how not only is he not rich or famous or accomplished or particularly good-looking but he cannot even control his own bowels and therefore is better suited for the company of animals or infants than of adults, let alone adults as luminous and significant as these.

  The sweaty young writer is also worrying about what will happen when someone tries to use the hallway bathroom.

  Late that night, after everyone had gone off to bed, I sneaked back down to the bathroom with a garbage bag and paper towels and cleaning detergent I’d purloined from the pantry. I couldn’t tell whether anyone had been there since I left, but I tried not to worry about that and concentrated on stuffing the soiled rug and towels and clothes and toilet paper I’d stashed under the sink into the trash bag. Then I used the paper towels to scrub the floors, and I put those into the trash bag as well.

  Outside the kitchen, between the main house and an outbuilding, was a Dumpster. My plan was to dispose of everything there. Naturally, I was terrified of getting caught. What, exactly, would a houseguest be doing disposing of a large trash bag outside in the middle of the night? (I worried that there might still be Secret Service afoot, who might shoot me before allowing me to plant what looked like a bomb or a body in the Dumpster.) But what choice did I have? I slunk through the house and out to the Dumpster, where I deposited the trash bag. Then I went back upstairs to bed.

  No one ever said anything to me about the hallway bathroom or about the missing rug and towels. But for the rest of the weekend, and on my subsequent visits there, I was convinced that the household staff were glaring at me and whispering. “That’s him,” I imagined they were saying in disgust. “The one who broke the toilet and ruined our towels. The one who can’t control his own bodily functions.”b

  Most persons with a sore colon are of a tense, sensitive, nervous temperament. They may be calm externally, but they usually seethe internally.

  —WALTER C. ALVAREZ, Nervousness, Indigestion, and Pain (1943)

  Of course, I know that such shame should not attach to what is, officially, a medical condition. Irritable bowel syndrome is a common gastrointestinal complaint frequently associated with mood and anxiety disorders, as has been observed since ancient times. In 1943, the eminent gastroenterologist Walter Alvarez noted in his delightfully titled Nervousness, Indigestion, and Pain that there is no more reason a person should feel ashamed about a nervous stomach than someone should feel ashamed at blushing at a compliment or weeping at a sad play. The nervousness and hypersensitivity that such physical reactions produce, Alvarez wrote, are associated with personality traits that, if “properly used and controlled,” can “do much to help a man succeed.”c

  But a nervous stomach is bad enough—what’s most disabling to me is that my nervous stomach itself makes me nervous. That’s the infernal thing about being an anxious emetophobe: the very fact of one’s stomach hurting is itself often the most acute source of fear. Any time your stomach hurts, you worry you might vomit. Thus being anxious makes your stomach hurt, and your stomach hurting makes you anxious—which in turn makes your stomach hurt more, which makes you more anxious, and so on and so forth in a vicious cycle that hurtles rapidly toward panic. The lives of emetophobes are largely built around their phobia—some have not worked or left their houses for years because of their fears and cannot bear even to say or write “vomit” or related words. (Online emetophobia communities usually have rules requiring that such words be rendered as, for instance, “v**.”)

  Until recent years, emetophobia rarely appeared in the clinical literature. But the arrival of the Internet provided a means for emetophobes, many of whom had previously believed they were alone in their affliction, to find one other.d Online communities and support groups sprouted. The appearance of these virtual commu
nities, some of which are quite large (by one estimate, the forum of the International Emetophobia Society has five times as many members as the largest flying phobia forum), came to the attention of anxiety researchers, who have started to study this phobia more systematically.

  Like all anxiety disorders, emetophobia presents with elevated levels of physiological arousal, avoidance behavior (and also what experts call safety, or neutralizing, behavior, by which they mean doing what I do: carrying stomach remedies and antianxiety medications in case of emergency), attention disruption (meaning that in the presence of a phobic stimulus, such as a virus going around the office or through the family, we can concentrate on little else), and, typically, problems with self-esteem and self-efficacy. We emetophobes tend to think poorly of ourselves and to believe we have trouble coping with the world, and especially with something as catastrophic-seeming as vomiting.e

  As we’ve seen, both patients with panic disorder and patients with irritable bowel syndrome (who much of the time are the same patients) have what mental health experts call “high somatization vulnerability” (that is, a tendency to convert emotional distress into physical symptoms) and “cognitive biases in the discrimination and interpretation of bodily symptoms” (that is, they are especially conscious of even minor changes in physiology and have an attendant predisposition to interpret those symptoms in a catastrophic, worst-case-scenario way). But whereas the primary concern for most panic patients tends to be that anxious bodily symptoms augur a heart attack or suffocation or insanity or death, emetophobes are afraid that the symptoms foretell imminent vomiting (and also insanity and death). And whereas the fears of the panic patients are, except in rare cases of anxiety-induced sudden cardiac death, extremely unlikely to be realized, emetophobes are quite capable of bringing on, through their anxious symptoms, the very thing they fear most. Which, of course, is another reason to be constantly afraid of being constantly afraid. Is it any wonder that sometimes I feel like my brain is turning inside out?