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

by Scott Stossel

  My sister, who has for years suffered from social anxiety, strongly endorses this view. Without knowing anything about neurobiology, she has long insisted that her brain is “wired wrong.”

  “Social situations that normal people breeze through unthinkingly cause my brain to shut down,” she says. “I can never think of what to say.”

  Though her brain otherwise functions well (she’s a successful cartoonist, editor, and children’s book author who graduated from Harvard), she has, ever since junior high, wrestled with what she calls her “talking problem.” Neither decades of psychotherapy nor dozens of drug combinations have much alleviated it. She has been evaluated for Asperger’s syndrome and other disorders on the autism spectrum, but she doesn’t lack empathy the way Asperger’s patients do.o

  The association of dopamine and serotonin with social phobia doesn’t prove that neurotransmitter deficits cause social anxiety—those irregularities could be the effects of social anxiety, the neurochemical “scars” that develop when a brain becomes overstressed from having to be so vigilant all the time, constantly scanning the environment for social threats. But emerging research suggests that the efficiency with which dopamine and serotonin get ferried across the synapses is genetically determined. Researchers have found that which variant of the serotonin transporter gene you have determines the density of serotonin receptors in your neurons—and that the relative density of your serotonin receptors helps determine where you fall on the spectrum between shy and extroverted.p

  The introduction of social uncertainty into a group of baboons does interesting things to rates of anxiety. Low-ranking baboons are always stressed. But Robert Sapolsky has found that whenever a new male joins the troop, the glucocorticoid levels of all the baboons—not just the low-ranking ones—become elevated. With the introduction of new members into a social hierarchy, appropriate rules of conduct, such as who should defer to whom, become unclear; there are more fights and general agitation. Once the new baboon has been assimilated into the tribe, stress levels and glucocorticoid concentrations decline, and social behavior returns to normal.

  This also happens in humans. In the late 1990s, Dirk Hellhammer, a German psychobiologist, coded sixty-three army recruits at boot camp according to their relative position in the social hierarchy (as determined by anthropological observation) and then measured their cortisol levels every week. During stable periods, the more dominant recruits had lower baseline levels of salivary cortisol than the subordinate ones—just like baboons. But during periods of experimentally induced psychological and physical stress, cortisol levels increased in all the soldiers—markedly in the dominant subjects and modestly in the subordinate ones. While it’s always stressful being a low-ranking member of the tribe, disruptions to the social order seem to make everyone, even the high-ranking members, stressed.q

  Many of us have strived for perfection in order to try to control our world.… There is generally a deep-seated feeling of not being good enough, of being deficient or defective in some way, or of being different from others in a way that will not be accepted by others. This creates a feeling of shame and a fear of embarrassment and humiliation in exposing your true self in front of others.

  —JANET ESPOSITO, In the Spotlight (2000)

  Recently, while sifting through the records from my treatment with Dr. M. nearly a decade ago, I came across a document I’d written at her request. She had asked me to write down what the outcome of a worst-case-scenario public speaking catastrophe would be for me. The idea behind this sort of exercise is to fully imagine the worst thing that could happen (total failure, complete humiliation) and then, once you’ve really thought about it, to conclude that, first, the worst-case scenario was unlikely to unfold and, second, even if it did, maybe it would not be so shatteringly catastrophic. Reaching that conclusion, and assimilating it intellectually and emotionally, is supposed to lower the stakes of the performance and therefore diminish anxiety.

  That’s the theory anyway. But when I showed up at my lunchtime appointment one Thursday after having e-mailed her my imagined worst-case public speaking scenario (humiliation and physical collapse followed by unemployment, divorce, and ostracism from society), Dr. M. looked stricken.

  “Your write-up,” she said. “It’s the most negative thing I’ve ever read.” She told me she had been horrified at what I’d written and had felt compelled to show my account to her department supervisor in search of more experienced counsel. As she looked at me with sympathy, concern, and, I believe, no small alarm, I suspected she’d raised the question of whether I might be gravely depressed and possibly psychotic.

  Perhaps I have an overactive imagination; perhaps I’m unduly pessimistic. But I now know that negativity and poor self-image—along with a desperate desire to conceal that poor self-image—are textbook for a social phobic. Nearly every book on the subject, both popular and academic, observes that social anxiety disorder is associated with feelings of inferiority and with extreme sensitivity to any kind of criticism or negative evaluation.r

  “Jeez,” Dr. W. said to me one day when I was explaining to him the high stakes I ascribed to an upcoming public event and how important I thought it was to maintain my façade of efficacy and to hide my sense of fraudulence and weakness. “Do you realize how potently your sense of shame contributes to your anxiety?”

  Both Dr. M. and Dr. W.—not to mention Epictetus—would say that the best cure for this kind of social anxiety is to diminish the power of shame. The embarrassing exposures that Dr. M. subjected me to were designed to inure me somewhat to feelings of shame.

  “Go ahead, put it out there,” Dr. W. says, speaking of my anxiety. “You may be surprised by how people respond.

  “Stop caring so much about what other people think,” he says, echoing the advice of a hundred self-help books.

  If only it were that easy.

  The day I’m not nervous is the day I quit. To me, nerves are great. That means you care, and I care about what I do.

  —TIGER WOODS, AT A PRESS CONFERENCE BEFORE THE 2009 WGC-ACCENTURE MATCH PLAY CHAMPIONSHIP

  I don’t give a shit what you say. If I go out there and miss game winners and people say, “Kobe choked” or “Kobe is seven for whatever in pressure situations,” well, fuck you. Because I don’t play for your fucking approval. I play for my own love and enjoyment of the game. And to win. That’s what I play for. Most of the time, when guys feel the pressure, they’re worried about what people might say about them. I don’t have that fear, and it enables me to forget bad plays and to take shots and play my game.

  —KOBE BRYANT, DURING AN INTERVIEW FOLLOWING GAME 3 OF THE 2012 NBA WESTERN CONFERENCE SEMIFINALS

  One day in seventh grade, while playing my classmate Paul in a tennis match, I become overwhelmed with anxiety. My stomach is distended; I am burping uncontrollably. Before the match started, the most important thing was that I win. But now that I am in the middle of the match and my stomach hurts and I am afraid of throwing up, the most important thing is that I get off the court as quickly as possible. And the quickest way to do that is to lose. And so I hit balls out. I hit them into the net. I double-fault. I lose 6–1, 6–0, and when I shake hands and get off the court, the first thing I feel is relief. My stomach settles. My anxiety relents.

  And the next thing I feel is self-loathing. Because I have lost to the overweight and oleaginous Paul, who is now strutting around proudly, crowing about how badly he has beaten me. The stakes are low: it is a challenge match for one of the lower ladder positions on the middle-school junior varsity. But to me they feel existentially high. I have lost to Paul, who is not a particularly good player—his skills, his quickness, his fitness are manifestly worse than mine—and the result is there on the score sheet and on the ladder hanging on the locker room wall and radiating from Paul’s puffed-out chest, for all to see: he has won, so he is superior to me. I have lost; I am therefore, by definition, a loser.

  This sort of thing—purposely
losing matches to escape intolerable anxiety—happened dozens of times throughout my school sports career. Not every thrown match was as egregious as the one against Paul (whose name, by the way, I have changed here)—I often tanked matches against players who would likely have beaten me even if I hadn’t suffered an anxious meltdown—but some of them were. My coaches were baffled. How could it be, they wondered, that I could look so skillful in practice and yet so rarely win a significant match?

  The exception was tenth grade, when I played for the junior varsity squash team and went undefeated: 17–0 or something. What, you might ask, accounts for that?

  Valium.

  Squash matches, even squash practices, were making me so miserable that the child psychiatrist I was seeing then, Dr. L., prescribed a small dose of the benzodiazepine. Every day during squash season that year, I took the pill surreptitiously with my peanut butter sandwich at lunch. And I didn’t lose a match. I was still unhappy during squash season: my agoraphobia and separation anxiety made me hate traveling to matches, and my competitive anxieties still made me hate playing in them. But the Valium took enough of the physical edge off my nerves that I could focus on trying to play well instead of on trying to get off the court as quickly as possible. I didn’t feel compelled to lose matches on purpose anymore. Drugs got me into the zone of performance where anxiety is beneficial.

  In 1908, two psychologists, Robert M. Yerkes and John Dillingham Dodson, published an article in The Journal of Comparative Neurology and Psychology demonstrating that animals trained to perform a task performed it slightly better if they were made “moderately anxious” beforehand. This led to what has become known as the Yerkes-Dodson law, whose principles have been experimentally demonstrated in both animals and humans many times since then. It’s kind of a Goldilocks law: too little anxiety and you will not perform at your peak, whether on a test or in a squash match; too much anxiety and you will not perform well; but with just the right amount of anxiety—enough to elevate your physiological arousal and to focus your attention intensely on the task, but not so much that you are distracted by how nervous you are—you’ll be more likely to deliver a peak performance. For me, evidently, getting from the too-anxious part of the curve to the optimum-performance part required a small dose of Valium.s

  I wish I could say competitive anxiety was merely an adolescent phase. But about ten years ago, I found myself playing in the finals of a squash tournament against my friend Jay, a personable young physician. It was championship night at the squash club, and a couple of dozen people had turned out to watch. We were two just-better-than-average club players; absolutely nothing of significance (no money, hardly a trophy to speak of) was on the line.

  In this tournament, matches were best of five games; to win a game you needed nine points. I jumped out confidently to an early lead in the first game, but I let it slip away. I won the second game; Jay won the third. My back against the wall, I won the fourth, and Jay sagged visibly. I could see that he was tired—more tired than I was. In the fifth and deciding game, I pulled steadily ahead and got to 7–3, two points away from victory. Jay looked defeated. Victory was mine.

  Except it wasn’t.

  The prospect of imminent victory sent anxiety cascading through my body. My mouth went dry. My limbs grew impossibly heavy. Worst of all, my stomach betrayed me. Overwhelmed with nausea and panic, I hit weak shots, desperate shots. Jay, moments earlier disconsolate and resigned to losing, perked up. I’d given him a ray of hope. He gained momentum. My anxiety mounted, and suddenly it was like I was back in seventh grade, playing tennis against Paul: all I want is out. I withered before everyone’s eyes. I began, on purpose, to lose.

  Jay seized his opportunity, Lazarus from the grave, and beat me. Afterward, I tried to be gracious in defeat, but when everyone inevitably commented on how dramatically I had blown my near victory, I attributed my collapse to back trouble. My back did hurt—but it was not why I lost. I had the championship in my clutches, and I let it slip away because I was too anxious to compete.

  I choked.

  Just about the worst epithet one can sling at an athlete—worse, in some ways, than “cheater”—is “choker”: to choke is to wilt under pressure, to fail to perform at the moment of greatest importance. (A technical definition, as laid out by Sian Beilock, a University of Chicago cognitive psychologist who specializes in the topic, is “suboptimal performance—worse performance than expected given what a performer is capable of doing and what this performer has done in the past.”) The etymological stem of “anxious”—anx—comes from the Latin angere, which means “to choke”; the Latin word anxius probably referred to the feeling of chest constriction experienced during a panic attack. To choke, in an athletic or any other kind of performance context, implies an absence of fortitude, a weakness of character. The most common explanation for choking in a sporting event is, in the shorthand of the sports reporter, “nerves.” Choking, in other words, is produced by anxiety—and in the sporting arena, as well as on the field of battle or in the workplace, anxiety is ipso facto a sign of weakness.

  Since my collapse in the club finals that year, I have learned the beneficial effects of prematch meditation and have gotten better at titrating my dosages of prophylactic antianxiety medication. My wife has also borne us two children, which should have put into perspective the existential insignificance of a recreational sporting event. And yet the problem persists.

  Not long ago, I found myself in the semifinals of another squash tournament.

  “Why do you play in these tournaments if they make you so miserable?” Dr. W. had asked me several years earlier. “If you can’t learn to enjoy them, stop torturing yourself by playing in them!”

  And so I had stopped for a while. And when I started again, I did so with a conscious lack of emotional investment. I’m just doing it for the exercise, I tell myself. I can enjoy the competition without making myself anxious and miserable about the outcome. And through the first rounds of this tournament, I do. Sure, there are tense moments; at times I feel pressure, which fatigues me and diminishes the quality of my play. But that’s normal, the vicissitudes of competition; it doesn’t debilitate me. And I keep winning.

  So when I step out onto the court for the semifinals, I tell myself, I still do not care. Only five people are watching. I lose a close first game. But it’s fun. No big deal. I don’t care. My opponent is good. I should lose this match. No expectations, no pressure.

  But then I win the next game. Wait a minute, I think. I’m in this match. I could win it. The moment my competitive impulse surges, the familiar heaviness descends and my stomach inflates with air.

  C’mon, Scott, I tell myself. Have fun. Who cares who wins?

  I try to relax but my breathing is getting heavier. I’m sweating more profusely. And as word spreads that the match is a close one, more people begin gathering behind the court to watch.

  I try to slow everything down—my breathing, the pace of my play. As my anxiety rises, the quality of my game deteriorates. But I am still, for the moment anyway, focusing on trying to play well, on trying to win. To my surprise, my slowing-the-pace-down strategy works: I come from behind to win the third game. One more game and I will be in the championship.

  At which point I find I am so enervated by my anxiety that I can no longer play. My opponent wins the next game quickly, evening the match at 2–2. Whoever wins the next game will be into the finals.

  I use the allotted two-minute break between games to retreat to the men’s room to try to collect myself. I am pale and shaking—and, most terrifying to me, nauseated. As I walk back out on the court, the referee asks if I am okay. (I clearly do not look well.) I mumble that I am. The fifth game begins, and I no longer care at all about winning; as in my match against Paul thirty years earlier, I care only about getting off the court without vomiting. Once again, I start trying to lose as quickly as possible: I stop running for the ball; I shank balls on purpose. My opponent is puzzled. Aft
er I fail to run for an easy drop shot, he turns and asks me if I’m okay. Mortified, I nod that I am.

  But I am not okay. I am terrified that I will not be able to lose enough points quickly enough to get off the court before retching and humiliating myself. In seventh grade, at least, I had been able to stay on the court until the end of the match with Paul; this time, with so many eyes upon me and my gorge rising, I cannot do even that. Two points later, with the match many points from conclusion, I raise my hand in defeat.

  “I concede,” I say to my opponent. “I’m sick.” And I scurry off the court in defeat.

  I have not just lost. I have given up. Folded like a cheap lawn chair. I feel mortified and pathetic.

  Friends in the audience murmur words of consolation in my direction. “We could tell you weren’t feeling well,” they say. “Something wasn’t right.” I shake them off (“Bad fish for lunch,” I mumble) and retreat to the locker room. As ever, once I am out of the competitive moment, and out of public view, my anxiety recedes.

  But I have lost to another opponent I might well have beaten. In truth, I don’t really care about the losing. What bothers me is that, yet again, my anxiety has defeated me, reduced me to a helpless mass of quivering jelly and exposed me to what feels like minor public embarrassment.