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

by Scott Stossel

  b These findings are controversial and continue to be debated fiercely on psychiatry and psychology blogs.

  c Much more so than in, say, France, where tranquilizer consumption rates are higher, but perhaps even less so than in Japan, where SSRI consumption rates are much lower.

  d Another colleague of Dr. W.’s—let’s call him Dr. G.—was an eminent psychoanalytically trained psychiatrist who, late in his career, fell into a severe clinical depression. Dr. G. checked himself into Chestnut Lodge, a psychoanalytically oriented psychiatric hospital in Rockville, Maryland. For years, Dr. G. had been a professional opponent of biological psychiatry, arguing that Freudian talk therapy was the best way to treat anxiety and depression. But daily sessions of analytic psychotherapy provided Dr. G. no relief from his suffering. Only when he consented to go on antidepressants did his condition improve. Dr. G.’s depression lifted—but he now found himself confronted with a professional crisis: Was psychoanalytic psychotherapy, the foundation on which he’d built his career, a chimera? He died not long thereafter.

  e Edward Drummond, a psychiatrist in New England, used to regularly prescribe benzodiazepine tranquilizers to his patients in order to reduce their anxiety. Today, he strongly believes tranquilizers are a significant cause of chronic anxiety. Taking Xanax or Ativan can temporarily alleviate acute anxiety, Drummond says, but at the cost of allowing us to avoid dealing with whatever issues are causing that anxiety.

  f Percy’s conversion prompted his best friend, the novelist and Civil War historian Shelby Foote, to tell him, “Yours is a mind in full intellectual retreat.”

  g Peter Kramer makes observations along these lines in Listening to Prozac.

  h Themes of anxiety, nervous disorders, and existential dread run through much of Percy’s writing. In The Second Coming, Will Barrett, a retired lawyer, must cope with a strange affliction that descends on him after the death of his wife, a feeling of depression accompanied by a disturbance of his internal gyroscope, a hitch in his golf swing, and what his doctors believe may be petit mal seizures. Will suspects his neurotic ailment is caused by the world’s being “farcical.” But one doctor suspects “a small hemorrhage or arterial spasm near the brain’s limbic system.” Is Will’s unhappiness a problem of meaning? Or a quirk of biology?

  As the novel progresses, Will’s malaise deepens; his fainting spells become more frequent, and he becomes filled with religious yearning. Eventually, his family commits him to the hospital, where a doctor diagnoses him with Hausmann’s syndrome, a disease (invented by Percy) whose symptoms include, in addition to seizures, “depression, fugues, certain delusions, sexual dysfunction alternating between impotence and satyriasis, hypertension, and what [Dr. Hausmann] called wahnsinnige Sehnsucht”—“inappropriate longing.” The disease is caused, Will’s doctors explain, by a simple pH imbalance and is treated by the simplest of drugs—a hydrogen ion, a single nucleus of one proton. Will is consigned to a nursing home, where his pH levels can be checked every few hours. “Remarkable, don’t you think,” says his doctor, “that a few protons, plus or minus, can cause such complicated moods? Lithium, the simplest metal, controls depression. Hydrogen, the simplest atom, controls wahnsinnige Sehnsucht.” Will, ostensibly cured and living his circumscribed nursing-home existence, marvels: “How odd to be rescued, salvaged, converted by the hydrogen ion! A proton as simple as a billiard ball! Did it all come down to chemistry after all? Had he … pounded the sand with his fist in a rage of longing … because his pH was 7.6?”

  Percy, writing here in the late 1970s, when the “catecholamine hypothesis of affective disorders” and “norepinephrine theory of depression” were taking hold, is mocking the pretensions of biological reductionism. By reducing Will’s humanity—not only his depression but his ideas and his longings—to his hydrogen molecules, Percy is essaying a critique of modern psychopharmacology, which in his view pathologizes alienation.

  Seven years later, on the eve of Prozac’s American launch, Percy published an even blunter critique of biological materialism. The Thanatos Syndrome featured a character named Thomas More, a psychiatrist who had appeared in an earlier novel, Love in the Ruins. In The Thanatos Syndrome, Dr. More, who has recently been released from jail, where he had been serving time for illegally selling the benzodiazepine Dalmane at truck stops, returns to his hometown of Feliciana, Louisiana, to find everyone acting strangely. The women of his town have developed a propensity for presenting themselves rearward for sex. His own wife, in addition to exhibiting this predilection, has developed a computerlike aptitude for playing bridge that has propelled her to success in national tournaments. He notes that anxious women have suddenly lost weight and self-consciousness while gaining boldness, sexual voracity, and emotional insensitivity. They shed “old terrors, worries, rages … like last year’s snakeskin, and in its place is a mild fond vacancy, a species of unfocused animal good spirits.” It turns out that some supercilious civic leaders—including the director of the Quality of Life Division, a federal agency that oversees euthanasia programs—have taken it upon themselves to introduce a chemical called heavy sodium into the water supply, like fluoride, in an effort to “improve” the social welfare. Heavy sodium makes people more placid, less self-conscious, and more content. This is not necessarily a good thing: in losing their anxiety and self-consciousness, the citizens of Feliciana are becoming less human. Dosed with heavy sodium, Feliciana’s women are no longer “hurting, they are not worrying the same old bone, but there is something missing, not merely the old terrors, but a sense in each of her—her what? her self?” Dr. More is skeptical, but the heavy sodium advocates try to argue him around to their way of thinking. “Tom, we can see it!” one zealous champion tells him. “In a PETscanner! We can see the glucose metabolism of the limbic system raising all kinds of hell and getting turned off like a switch by the cortex. We can see the locus ceruleus and the hypothalamus kicking in, libido increasing—healthy heterosexual libido—and depression decreasing—we can see it!” Mocking the arrogance of biological psychiatry, Percy means to warn that to medicate away guilt, anxiety, self-consciousness, and melancholy is to medicate away the soul.

  PART IV

  Nurture Versus Nature

  CHAPTER 8

  Separation Anxiety

  The great source of terror in infancy is solitude.

  WILLIAM JAMES, The Principles of Psychology (1890)

  When did my anxiety begin?

  Was it when I, as a toddler, would throw epic tantrums, screaming relentlessly and banging my head on the floor?

  The questions that confronted my parents were these: Was my behavior merely a slightly extreme but nonetheless typical manifestation of the terrible twos—or did it lie outside the band of the normal? What is the difference between childhood separation anxiety as a normal developmental stage and separation anxiety as a clinical, or preclinical, condition? Where is the line between temperamental inhibition as a normal personality trait and inhibition as a symptom of pathology—a sign of, say, incipient social anxiety disorder?

  On the matter of my tantrums, my mother’s Dr. Benjamin Spock manual was not dispositive, so she took me to the pediatrician and described my behavior. “Normal,” was his conclusion, and his advice, in keeping with the laissez-faire approach to child rearing of the early 1970s, was to let me “cry it out.” So my parents would watch in distress as I lay on the floor, screaming and writhing and smashing my head on the ground, sometimes for hours at a time.

  Then what to make of my extreme shyness at age three? When my mother took me to my first day of nursery school, she couldn’t (or wouldn’t—separation anxiety cuts both ways with children and parents) leave because I clung to her leg and whimpered. Still, separation anxiety in a three-year-old is well within the spectrum of normal developmental behavior, and eventually I was able to stay at school for three mornings a week by myself. And while I clearly exhibited signs of an “inhibited temperament”—shy, introverted, withdrawing from unfa
miliar situations (and in a lab I probably would have displayed a hair-trigger startle reflex and high levels of cortisol in my blood)—none of this was necessarily evidence of emerging psychopathology.

  Today, it’s not hard to see that my early behavioral inhibition was a harbinger of my adult neurosis—but that’s only in retrospect, seeing my anxiety as an unfolding narrative.

  At age six, when I was in first grade, two new problems set in. The first was an intensified resurgence of my separation anxiety (about which more in a moment). The second was the onset of emetophobia, or the fear of vomiting, my original, most acute, and most persistent specific phobia.

  The first presenting symptom for some 85 percent of adults with anxiety disorders, according to data collected by Harvard Medical School researchers, is a specific phobia developed as a child. The same data, based on interviews with a quarter of a million people around the world, has also revealed that early experiences with anxiety tend to compound and metastasize. A child who develops a specific phobia—say, a fear of dogs—at age six is nearly five times more likely than a child without a fear of dogs to develop social phobia in her teenage years; that same child is then 2.2 times more likely than a child without an early dog phobia to develop major depression as an adult.

  “Fear disorders,” says Ron Kessler, the head of the Harvard study, “have a very strong pattern of comorbidity over time, with the onset of the first disorder strongly predicting the onset of a second, which strongly predicts the onset of a third, and so on.” (“Comorbidity” is the medical term for the simultaneous presence of two chronic diseases or conditions in a patient; anxiety and depression are often comorbid, with the presence of one predicting the presence of the other.) “Fear of dogs at age five or ten is important not because fear of dogs impairs the quality of your life,” Kessler says. “Fear of dogs is important because it makes you four times more likely to end up a 25-year-old, depressed, high-school dropout single mother who is drug dependent.”*

  While the nature of the link between childhood phobia and adult psychopathology is not clear, the fact of it is—which is why Kessler insists that early diagnosis and treatment is so important. “If it turns out that dog phobia does somehow cause adult psychopathology, then the successful early treatment of phobic children could reduce later incidence of depression by 30 to 50 percent. Even if it’s only by 15 percent, that’s significant.”

  The numbers from Kessler’s study would seem to lend a statistical fatedness to the progression of my anxiety: from specific phobia at age six to social phobia starting around age eleven to panic disorder in my late teens to agoraphobia and depression in young adulthood. I have been, in my pathogenesis—the development of my pathology—a textbook case.

  Missing someone who is loved and longed for is the key to an understanding of anxiety.

  —SIGMUND FREUD, Inhibitions, Symptoms, and Anxiety (1926)

  When I was six years old, my mother started attending law school at night. My father says this was at his instigation, because he’d seen how my mother’s mother had become depressed and alcoholic as a stay-at-home suburban housewife without professional aspirations. My mother, for her part, says that it was over my father’s objections that she started studying law. She adds, furthermore, that her mother was neither depressed nor an alcoholic. (My mother is presumably the better authority here, but for what it’s worth, my grandmother, whom I loved dearly, often did smell appealingly of gin.)

  The powerful recrudescence of my separation anxiety coincided with the beginning of my mother’s first year in law school. Each day during first grade, I would be driven home from school in a car pool to be greeted by one of a series of neighborhood babysitters. The babysitters were all very nice. Nevertheless, nearly every evening ended the same way: with me pacing around my bedroom waiting desperately for my father to come home from work. Because nearly every night for about four years—and then intermittently for about ten more years after that—I was convinced that my parents were not coming home, that they had died or abandoned me, and that I had been orphaned, a prospect that was unbearably terrifying to me.

  Even though every night provided yet another piece of evidence that my parents always did come home, that never provided reassurance. This time, I was always convinced, they’re really not coming back. So I would pace around my room, and sit on the radiator peering hopefully out the window, and listen desperately for the rumble of my father’s Volkswagen. He was supposed to be home by no later than 6:30, so as the clock clicked past 6:10 and 6:15, I would begin suffering my nightly paroxysms of anxiety and despair.

  Sitting on the radiator, nose pressed up against the window, I’d try to will him home, mentally picturing his return—the Volkswagen turning off Common Street and onto Clark Street, heading up the hill and left onto Clover, then right onto our street, Blake—and then I’d look down the street and listen for the rumble of the car. And … nothing. I’d stare at my bedroom clock, my agitation increasing as the seconds ticked by. Imagine you have just been told that a loved one has died in a car crash. Every night produced the same fifteen to thirty minutes of effectively believing I had been told just that—a half hour of exquisite agony during which I was absolutely, resolutely convinced that my parents had died or that they had abandoned me—even as the babysitter blandly played board games with my sister downstairs. And then finally, usually by six-thirty and almost always by seven, the Volkswagen would come motoring down the street and turn into the driveway, and a burst of relief-borne euphoria would cascade through me: He’s home, he’s alive, I haven’t been abandoned!

  And then the next night I would go through this all over again.

  Weekends when my parents went out together were even worse. My fears of abandonment were not rational. Most of the time I was convinced my parents had died in a car crash. Other times I was sure they had simply decided to leave—either because they didn’t love me anymore or because they weren’t really my parents after all. (Sometimes I thought they were aliens; sometimes I thought they were robots; at times I was convinced that my sister was an adult midget who had been trained to play the part of a five-year-old girl while her colleagues, my parents, performed whatever experiments they were carrying out before abandoning me.)

  My mother, more attuned to my anxiety than my father was, clued into how I would start my worrying well in advance of when they had promised to be home. So when they were leaving and I would ask, ritually, “What’s the latest you’ll be back?” my mother would announce a time fifteen or twenty minutes later than when she actually estimated they would return. But I cottoned on to this gambit soon enough, so I would factor in that extra time and begin my worried pacing forty-five minutes or an hour before the stated latest time. And my mother, picking up on this, moved her stated return time still later, but I would pick up on that—and we were off and running on a kind of arms race of stated and assumed return times that eventually rendered anything she said meaningless to me, so my anxiety would rise from the moment they left.

  This weekend worrying went on, I hate to say, for a long time. As a young teenager, I sometimes called (or forced my sister to call) parties my parents were at to make sure they were still alive. On several occasions I woke neighbors (and once the minister of the Episcopal church around the block) by banging on their doors late in the evening to tell them that my parents weren’t home and that I thought they might be dead and to please call the police. When I was six, this was embarrassing to my parents; when I was thirteen, it was mortifying.

  By the time I was twelve, even being alone in my room at night—down the hall from my parents, less than fifteen feet away—had become an ordeal. “Do you promise everything will be okay?” I would ask my mother when she tucked me in at night. As my emetophobia got worse, I worried I would wake up vomiting. This made me anxious and queasy at bedtime. Feeling that way one night, I told my mother, “I’m not feeling well. Can you please be especially on the alert tonight?” She said she would be. But t
hen a few nights later, I must have been feeling even more nervous than usual, because I said, “Can you please be especially, especially, especially on the alert tonight?” I remember the exact wording because I began asking that question every night. Eventually, this escalated into a ritual, one with a precise and weird sequence to it, that persisted until I went to college.

  “Do you promise everything will be okay?”

  “I promise.”

  “And will you be especially, especially, especially, especially, especially three hundred fifty-seven and a quarter times on the alert?”

  “Yes.”

  Like a psalm, with the stress always on the fifth “especially,” every night for years.

  My separation anxiety affected nearly every aspect of my life. I was a reasonably coordinated athlete as a preadolescent, but here’s how my first baseball practice ended: with me, age six, crying in the dugout, alongside a kindly but puzzled coach. (I never went back.)

  Here’s how my first beginners’ swimming lesson ended: with me, age seven, fearfully, tearfully refusing to get in the pool with the other children.

  Here’s how my first soccer practice ended: with me, age eight, crying on the sideline with the babysitter who’d brought me, resisting entreaties to join the other boys doing drills.

  Here’s how I spent my first morning at day camp, when I was five: sobbing by my cubby, crying that I missed my mommy and wanted to go home.

  Here’s how I spent the first two hours at my first (and only) overnight at camp, when I was seven: sobbing in the corner with a passel of befuddled counselors trying, serially and without success, to console me.