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

by Scott Stossel

  I know: the reality is that no one cares. Which somehow just makes this all the more pathetic.

  Never in my career have I experienced anything like what happened. I was totally out of control. And I couldn’t understand it.

  —GREG NORMAN, TO GOLF MAGAZINE ON BLOWING A LARGE LEAD AT THE 1996 MASTERS

  The list of elite athletes who have choked spectacularly, or who have developed bizarre and crippling performance anxieties, is extensive.

  Greg Norman, the Australian golfer, came unglued at the 1996 Masters, nervously frittering away a seemingly insurmountable lead over the final few holes; he ended up sobbing in the arms of the man who beat him, Nick Faldo. Jana Novotna, the Czech tennis star, was five points away from winning Wimbledon in 1993 when she disintegrated under pressure and blew a huge lead over Steffi Graf; she ended up sobbing in the arms of the Duchess of Kent. On November 25, 1980, Roberto Durán, then the reigning world welterweight boxing champion, squared off against Sugar Ray Leonard in one of the most famous bouts ever. With sixteen seconds left in the eighth round—and millions of dollars on the line—Durán turned to the referee, raised his hands in surrender, and pleaded, “No más, no más [No more, no more]. No more box.” He would later say his stomach hurt. Until that moment, Durán was perceived to be invincible, the epitome of Latino machismo. Since then, he has lived in infamy—considered one of the greatest quitters and cowards in sports history.

  These are all classic chokes—mental and physical collapses in isolated moments of high anxiety. More puzzling are those professional athletes who, in an excruciatingly public manifestation of performance anxiety, go into a kind of chronic choke. In the mid-1990s, Nick Anderson was a guard for the Orlando Magic. He entered the 1995 NBA finals as a solid free-throw shooter, having made about 70 percent of his foul shots throughout his career. But in the first game of the championship series against the Houston Rockets that year, Anderson had four consecutive opportunities to secure a victory for Orlando with a foul shot in the final seconds of regulation time: all he had to do was hit one shot.

  He missed all four. The Magic went on to lose that game in overtime, and then to lose the series in a four-game sweep. After that, Anderson’s free-throw percentage plummeted; for the remainder of his career, he was a disaster at the foul line. This caused him to play less aggressively on offense because he was afraid he’d get fouled and have to shoot free throws. The missed championship free throws, Anderson recalled later, were “like a song that got in my head, playing over and over and over.” He was driven to early retirement.

  In 1999, Chuck Knoblauch lost the ability to throw a baseball from second to first base. This would not have been a problem had he not happened to be, at the time, the starting second baseman for the New York Yankees. Knoblauch had no physical injury that would have impeded him—he could throw to first just fine during practice. During games, however, with forty thousand fans watching him in the stadium and millions more watching him on television, he repeatedly overthrew the base, launching the ball into the stands.

  Two decades earlier, just a year removed from being named the National League’s rookie of the year, Steve Sax, the second baseman for the Los Angeles Dodgers, developed the same affliction as Knoblauch. He had no trouble in practice, though, even successfully throwing blindfolded in an effort to break the habit.

  Most infamously there is Steve Blass, an All-Star pitcher for the Pittsburgh Pirates who, in June 1973, following a stretch when he was perhaps the best pitcher in baseball, was suddenly unable to throw the ball through the strike zone. In practice, he could throw as well as ever. But during games, he couldn’t control where the ball was going. After psychotherapy, meditation, hypnotism, and all manner of cockeyed home remedies (including wearing looser underwear) failed to cure him, he retired.

  Odder still are the examples of Mike Ivie and Mackey Sasser, catchers for the San Diego Padres and New York Mets, respectively. Both became so phobic about throwing the ball back to the pitcher—the sort of thing Little Leaguers do without trouble—that they ended up having to leave their positions. (The sports psychiatrist Allan Lans half jokingly coined the term “disreturnophobia” to describe this affliction.)

  The explicit monitoring theory of choking, derived from recent findings in cognitive psychology and neuroscience, holds that performance falters when athletes concentrate too much attention on it. Thinking too much about what you are doing actually impairs performance. This would seem to run counter to all the standard bromides about how the quality of your performance is tied to the intensity of your focus. But what seems to matter is the type of focus you have. Sian Beilock, who studies the psychology of choking at her lab at the University of Chicago, says that actively worrying about screwing up makes you more likely to screw up. To achieve optimal performance—what some psychologists call flow—parts of your brain should be on automatic pilot, not actively thinking about (or “explicitly monitoring”) what you are doing. By this logic, the reason Ivie’s and Sasser’s “disreturnophobia” became so severe was that they were thinking too much about what should have been the mindless mechanics of throwing the ball back to the pitcher. (Am I gripping the ball right? Am I following through in the right arm position? Do I look funny? Am I going to screw this up again? What’s wrong with me?) Beilock has found that she can dramatically improve athletes’ performance (at least in experimental situations) by getting them to focus on something other than the mechanics of their stroke or swing; having them recite a poem or sing a song in their head, distracting their conscious attention from the physical task, can rapidly improve performance.

  But anxious people generally can’t stop thinking about everything, all the time, in all the wrong ways. What if this? What if that? Am I doing this right? Do I look stupid? What if I make a fool of myself? What if I throw it into the stands again? Am I blushing visibly? Can people see me trembling? Can they hear my voice quavering? Am I going to lose my job or get demoted to the minors?

  When you look at brain scans of athletes pre- or midchoke, says the sports psychologist Bradley Hatfield, you see a neural “traffic jam” of worry and self-monitoring. Brain scans of nonchokers, on the other hand—the Tom Bradys and Peyton Mannings of the world, who exude grace under pressure—reveal neural activity that is “efficient and streamlined,” using only those parts of the brain relevant to efficient performance.

  In a sense, the anxiety exhibited by all these choking athletes is a version of the blushing problem: their fear of embarrassing themselves in public leads them to embarrass themselves in public. Their anxiety drives them to do the very thing they most fear. The more self-conscious you are—the more susceptible to shame—the worse you will perform.

  If you are a man you will not permit your self-respect to admit an anxiety neurosis or to show fear.

  —SIGNS POSTED ON ALLIED GUN SITES IN MALTA DURING WORLD WAR II

  In 1830, Colonel R. Taylor, the British consul in Baghdad, was exploring an archaeological excavation on the site of an ancient Assyrian palace when he came across a six-sided clay prism covered with cuneiform. The Taylor prism, which today is housed in the British Museum, tells of the military campaigns of King Sennacherib, who ruled Assyria in the eighth century B.C. The prism has been of great value to historians and theologians because of the contemporaneous accounts it provides of events described in the Old Testament. To me, however, the most interesting passage on the prism describes Assyria’s battle with two young kings of Elam (southwestern Iran on a modern map).

  “To save their lives they trampled over the bodies of their soldiers and fled,” the prism reads, recounting what happened when Sennacherib’s army overwhelmed them. “Like young captured birds they lost their courage. With their urine they defiled their chariots and let fall their excrements.”

  Here, in one of the earliest written records ever discovered, is the damning judgment cast on the weak stomach and moral character of the anxious warrior.

  Many of the sports trop
es about heroism, courage, and “grace under pressure” are also applied to war. But the stakes attending a sporting performance pale beside those attending performance in war, where the difference between success and failure is often the difference between life and death.

  Societies grant the highest approbation to soldiers (and athletes) who display grace under pressure—and harshly disparage those who falter under it. The anxious are inconstant and weak; the brave are stolid and strong. Cowards are governed by their fears; heroes are unperturbed by them. In his Histories, Herodotus tells of Aristodemus, an elite Spartan warrior whose “heart failed him” at the Battle of Thermopylae in 480 B.C.; he remained in the rear guard and did not join the fight. Thenceforth Aristodemus became known as the Trembler, and he “found himself in such disgrace that he hanged himself.”

  Militaries have always gone to considerable length to inure their soldiers to anxiety. The Vikings used stimulants made from deer urine to provide chemical resistance to fear. British military commanders historically girded their soldiers with rum; the Russian army used vodka (and also valerian, a mild tranquilizer). The Pentagon has been researching pharmacological means of shutting down the fight-or-flight response, with an eye toward eradicating battlefield fear. Researchers at Johns Hopkins University recently designed a system that would allow commanders to monitor their soldiers’ stress levels in real time by measuring the hormone hydrocortisone—the idea being that if a soldier’s stress hormones exceed a certain level, he should be removed from battle.

  Militaries denigrate fearful behavior for good reason: anxiety can be devastating to the soldier and to the army he fights in. The Anglo-Saxon Chronicle recounts the battle between England and Denmark that took place in 1003, in which Ælfric, the English commander, became so anxious that he began to vomit and could no longer command his men, who ended up being slaughtered by the Danes.

  Anxiety can spread by contagion, so armies seek aggressively to contain it. During the Civil War, the Union army tattooed or branded soldiers found guilty of cowardice. During World War I, any British soldier who developed neurosis as a result of war trauma was declared to be “at best a constitutionally inferior human being, at worst a malingerer and a coward.” Medical writers of the time described anxious soldiers as “moral invalids.” (Some progressive doctors—including W. H. R. Rivers, who treated the poet Siegfried Sassoon, among others—argued that combat neurosis was a medical condition that could affect even soldiers of stern moral stuff, but such doctors were in the minority.) A 1914 article in The American Review of Reviews argued that “panic may be checked by officers firing on their own men.” Until the Second World War, the British army punished deserters with death.

  The Second World War was the first conflict in which psychiatrists played a significant role, both as screeners of soldiers before combat and as healers of their psychic wounds afterward. More than a million U.S. soldiers were admitted to hospitals for psychiatric treatment of battle fatigue. But some senior officers fretted about what this more humane treatment of soldiers meant for combat effectiveness. George Marshall, the U.S. Army general who later became secretary of state, lamented that soldiers who on the front lines would be considered cowards and malingerers were considered by psychiatrists to be patients. The “hyperconsiderate professional attitude” of the psychiatrist, Marshall complained, would lead to an army of cosseted cowards. British generals stated in reputable medical journals that men who panicked during combat should be sterilized “because only such a measure would prevent men from showing fear and passing on to another generation their mental weakness.” High-ranking officers on both sides of the Atlantic argued that soldiers diagnosed with “war neurosis” should not be allowed to poison the gene pool with their cowardice. “It is now time that our country stopped being soft,” one British colonel declared, “and abandoned its program of mollycoddling no-goods.” For his part, General George Patton of the U.S. Army denied there was such a thing as war neurosis. He preferred the term “combat exhaustion” and said it was a mere “problem of the will.” In order to prevent combat exhaustion from spreading, Patton proposed to the commanding general, Dwight Eisenhower, that it be punishable by death. (Eisenhower declined to implement the suggestion.)

  Modern armies still struggle with what to do about soldiers undone by their combat-shattered nerves. During the Iraq war, The New York Times reported on an American soldier who had been dishonorably discharged for cowardice. The soldier contested his discharge, arguing it should have been an honorable one. He was not a coward, he said, but rather a medical patient suffering from a psychiatric illness: the stress of war had given him panic disorder, which caused him debilitating anxiety attacks. He was sick, his lawyers argued, not cowardly. The military, in this instance, initially refused to recognize the distinction—though Army officials later dropped the cowardice charges, reducing them to the lesser offense of dereliction of duty.

  Throughout history there have always been anxious soldiers, men whose nerve failed them and whose bodies betrayed them in crucial moments. After his first experience with combat, in 1862, William Henry, a young Union soldier of the Sixty-Eighth Pennsylvania Volunteers, suffered horrible stomach pains and diarrhea. Deemed by his doctors to be in otherwise good physical health, Henry was the first person to be formally diagnosed with “soldier’s heart,” a syndrome brought on by the stress of combat.t Studies of “self-soiling rates” among U.S. soldiers during World War II consistently found that 5 to 6 percent of combatants lost control of their bowels, with rates in some combat divisions exceeding 20 percent. Before landing on Iwo Jima in June 1945, American troops suffered rampant diarrhea; some soldiers used this as an excuse to avoid combat. A survey of one U.S. combat division in France in 1944 revealed that more than half of the soldiers broke out in cold sweats, felt faint, or lost control of their bowels during battle. Another survey of World War II infantrymen found that only 7 percent said they never felt fear—whereas 75 percent said their hands trembled, 85 percent said they got sweaty palms, 12 percent said they lost bowel control, and 25 percent said they lost bladder control. (Upon hearing that a quarter of survey respondents admitted to losing control of their bladders during battle, one army colonel said, “Hell … all that proves is that three out of four are damned liars!”) Recent findings issued by the Pentagon revealed that a high number of soldiers deployed in Iraq vomited from anxiety before going out on patrol in combat areas.

  William Manchester, who would go on to become an eminent American historian, fought at Okinawa during the Second World War. “I could feel a twitching in my jaw, coming and going like a winky light signaling some disorder,” he wrote, recalling his first experience of direct combat, in which he approached a Japanese sniper hiding out in a shack. “Various valves were opening and closing in my stomach. My mouth was dry, my legs quaking, and my eyes out of focus.” Manchester shot and killed the sniper—and then vomited and urinated on himself. “Is this what they mean by ‘conspicuous gallantry’?” he wondered.

  I would argue that Manchester’s anxious physiological reaction had an almost moral quality to it, a sensitivity to the existential gravity of the situation. Anxiety, as observers since Augustine have noted, can be usefully allied to morality; people who have no physiological reaction in these situations are the proverbial cold-blooded killers. As the writer Christopher Hitchens—no one’s idea of a coward—once put it, “Now, those who fail to register emotion under pressure are often apparently good officer material, but that very stoicism can also conceal—as with officers who don’t suffer from battle fatigue or post-traumatic stress—a psychopathic calm that sends the whole platoon into a ditch full of barbed wire and sheds no tears.”

  Nevertheless, there is a culturally accepted connection stretching back to ancient times between courage and manliness, as well as an approbative moral quality assigned to the ability to control one’s bodily functions when in extremis. Legend has it that when Napoleon needed a man “with iron nerve” f
or a dangerous mission, he ordered several volunteers before a fake firing squad and chose the one who “showed no tendency to move his bowels” when fired upon with blanks.

  My colleague Jeff, a journalist who has reported from war zones all over the world and has been kidnapped by terrorist organizations, says that neophyte war correspondents always wonder about what will happen the first time they find themselves pinned down by gunfire. “Until you’ve been under fire,” he says, “the question you ask yourself is, Will I shit my pants? Some do; some don’t. I didn’t—and I knew from then on I would be fine. But until it happens, you just don’t know.”

  Happily, I’ve never been fired upon. But I suspect I know into which category I would fall.

  A coward changes color all the time, and cannot sit still for nervousness, but squats down, first on one heel, then on the other; his heart thumps in his breast as he thinks of death in all its forms, and one can hear the chattering of his teeth. But the brave man never changes color at all and is not unduly perturbed, from the moment when he takes his seat in ambush with the rest.

  —HOMER, THE ILIAD (CIRCA EIGHTH CENTURY B.C.)

  Why do some people exhibit grace under fire while others fall so readily to pieces? Studies show that almost everyone—all but the most resilient and the most sociopathic—has a breaking point, a psychic threshold beyond which he or she can bear no more combat stress without emotional and physical deterioration or collapse. But some people can withstand lots of stress before breaking down and can recover from combat exhaustion quickly; others break down easily and recover slowly and with difficulty—if they recover at all.