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

by Scott Stossel

  How did this happen? This was a man who had manifestly thrived in his professional and family life. He had had tenure at Harvard for decades, had written a well-used political science textbook, and had been the academic dean of the college for many years. He had been married for thirty-two years. He enjoyed an active social life as a modest grandee of the Cambridge scene and often presided over morning chapel services for undergraduates. A father, a grandfather, a Harvard professor and dean, a member in good standing of the community—he had all the outward trappings of success, stability, and happiness. Yet inwardly he was crumbling.

  Today, my grandfather says that until his father broke down completely for the first time in the late 1940s, he had never seen any evidence that his father was anxious or depressed. Yet, according to his medical records, Chester had always been “a rather nervous person,” with a habit of—as his wife, Ruth, had first noticed when they were courting—constantly blinking his eyes. (Modern researchers sometimes use a measurement they call eyeblink frequency as a gauge of physiological anxiety.) Ruth also recalled the anxiety he had suffered over a series of lectures he had to give as a young assistant professor, reporting to his doctors that he had become “quite apprehensive and sleepless” for days in advance. Combing through old correspondence, I came across a letter Chester had written to Ruth while he was a junior professor at Harvard during the First World War, in which he declared that he almost hoped to be drafted for combat—because dodging bullets on the battlefield would be less nerve-racking than having to give lectures to undergraduates.

  All of this suggests that Chester had a nervous disposition—what Jerome Kagan would call a behaviorally inhibited temperament—that was almost certainly, to some degree, hereditary. Both his father and a maternal aunt were prone to various forms of anxiety and depression. But this nervous disposition, this behavioral inhibition, was not, for the first fifty years of his life, unduly debilitating: as apprehensive and susceptible to worry and insomnia as he could sometimes be, he progressed steadily along a dignified professional path, gaining esteem and respect as he went.

  So why, after more than five decades of managing his worry and melancholy, did he finally crack in the winter of 1947, surprising even himself?k According to the stress-diathesis model of mental illness, clinical disorders like anxiety and depression often erupt when a genetic susceptibility to psychiatric disease combines with life stressors that overwhelm the individual’s ability to cope. Certain people are blessed with genotypes programmed to withstand even severe trauma; other people, like my great-grandfather (and, presumably, me), are less naturally resilient and lose the ability to cope when the stress of life becomes too heavy.

  My great-grandfather was able to carry on his work until the Second World War. But as various colleagues were deployed to the war effort, his teaching load increased. “This put added strain on him,” his principal psychiatrist later reported, “and he became quite nervous and anxious about his ability to continue.” He became chronically tired. After years of hosting a salon at his home in Cambridge, he found himself too fatigued to entertain or even to socialize at all; dealing with people was too much of a strain. He suggested to James Conant, the president of Harvard, that he might resign. (For the moment, Conant requested that he stay on as dean.)

  In the spring of 1945, a close friend died. Already feeling worried and on edge, he became after this (according to his wife) perpetually “jittery”—a condition that was compounded as he surveyed the casualty lists from the war and saw the names of many of his former students. After years of teaching undergraduates, Chester suddenly could no longer organize his lectures. On several occasions, his wife had to write the lectures for the freshman seminar he taught.

  At the urging of his family physician, Roger Lee, he took a month off in the summer of 1946. “He felt better after this,” his records report, “and was able to continue fairly well through the next school year.” But the following spring, he again became upset over his inability to organize his work; he worried his lectures were inferior. He also worried obsessively about a trivial financial matter. Depression descended. He was able to carry out his teaching and administrative duties during the day, but at night he was driven to weeping by tension and sadness. Dr. Lee advised him to cut back on his workload, and so, in the fall of 1947, he retired as dean and returned to his full-time position in the government department, teaching courses in political science.

  At which point he deteriorated rapidly. By mid-October, he had become “overtired, nervous, and upset about his lectures and felt that he could not carry on.” He would stay up until two in the morning revising his lectures and yet still could not sleep because he was dissatisfied with his drafts, and so he would rise early the next day to begin work again. “He began to think he was not any good any more as a lecturer,” his McLean Hospital records say. “He began to think that other professors were better and that he was not up to his own standard.” The week before he was finally admitted to the hospital for the first time, he had become “even more apprehensive” about his lectures. At times he “wept bitterly,” and he had begun talking of suicide.

  In the “diagnostic impressions” section of Chester’s intake file, the hospital’s psychiatric director reports: “The patient gives the impression of having been an extremely valuable person in his professional life, as well as very kindly and helpful in his personal relations. He was overconscientious and overly self-critical, a person of high energy and work output, but a procrastinator. He was a worrier, and has a history of previous depression. Thus he has anxious and obsessional character traits. The change back from administrative to scholastic duties cut down the amount of satisfactory activity and of personal contacts, and increased the amount of contemplative, self-conscious and self-critical thinking. Dependent and despairing attitudes increased. He might be diagnosed as psychoneurosis, reactive depression. The prognosis seems fairly good for an easing of the present symptoms but the future of his adjustment is doubtful.”

  If Chester Hanford’s psychoneurotic ailments and his genotype—and, to a lesser degree, his life circumstances—are similar to my own, does that mean a fate like his awaits me? (“The future of his adjustment is doubtful.”) Does my heredity doom me to a similar downward spiral if I am subjected to too much stress? What might already have become of me if I had not had recourse to, at various times, the readily available antipsychotics, tricyclic and SSRI antidepressants, and benzodiazepines that were unavailable to my great-grandfather, who developed his affliction before the flowering of modern psychopharmacology? If my great-grandfather had had access to, say, Xanax or Celexa, would he have been spared the multiple rounds of electroshock and insulin coma therapy, not to mention the months spent moaning in his bed in a fetal ball?

  Impossible to say, of course. Whatever quotient of anxious and depressive genes we may share, Chester Hanford and I are different people, living in different times under different cultural conditions, with different experiences and different stresses. Maybe Celexa wouldn’t have worked on Chester Hanford. (As we have seen, the clinical evidence on SSRIs is mixed.) And, who knows? Maybe I could have muddled through without Thorazine and imipramine and Valium and desipramine and Prozac and Zoloft and Paxil and Xanax and Celexa and Inderal and Klonopin.

  But somehow I don’t think so. Which is what makes the similarities between us so disconcerting—and what makes me wonder if the difference between Holding It Together (as I’m doing now and as Chester Hanford anxiously did for so many years before finally breaking down) and Failing to Do So is some ingested chemical compounds that in whatever mysterious and imperfect way interact with my genotype to keep me suspended, tenuously, over the abyss.

  My great-grandfather’s first stay at McLean Hospital was relatively Edenic compared with his subsequent ones. Over the course of seven weeks, he had daily psychotherapy sessions, swam, played badminton and cards, read books, and listened to the radio. He also took various medications, which provide
a representative snapshot of the pharmacotherapy of the time.l

  In Chester’s daily psychotherapy sessions, his psychiatrist tried to boost his self-esteem and to reduce his anxiety by getting him to be less rigid in his thinking. Gradually, whether it was the talk therapy, the badminton, the drugs, the respite from work, or the passage of time, his anxiety lifted. (For what it’s worth, his principal psychiatrist gave greatest credit to the testosterone injections and the regular physical exercise.) He was released from the hospital on April 12, less depressed and no longer actively suicidal. But in his discharge records, his psychiatrist stated ominously that while the symptoms of anxiety had momentarily abated, his worry-prone temperament would likely trouble him again.

  A year later, he was back, readmitted on March 28, 1949, feeling, as the hospital director noted, “tense, anxious, depressed, and self-deprecatory” and suffering from “insomnia and an inability to concentrate on his work.” The day before returning to McLean, he had told Roger Lee, his family physician, that he wanted to kill himself but “did not have the guts for suicide.” Dr. Lee advised that he admit himself again to the hospital.

  Chester acclimated to life in a psychiatric hospital more quickly this time, and within ten days he already seemed to the staff to be more relaxed. But he was still talking about the same issues as on his previous admission—the anxiety, tension, and practical difficulties he was having in composing his lectures and the general inferiority he felt relative to his faculty peers.m

  As the doctors successfully “reassured him as to his own considerable value in the college community,” he became within a few weeks “a good deal more sociable and relaxed.” His psychiatrists believed that the combination of “relief from the responsibilities of work” and the positive boost he got from the injections of testosterone allowed his confidence to build up fairly quickly, and he was able to leave the hospital within a month.n

  My great-grandfather was at least somewhat improved for a time. He resumed his full teaching responsibilities at the college and returned to his scholarly work. For several years, it seems, he felt well and worked productively and effectively.

  Then he fell to pieces.

  At a faculty meeting on January 22, 1953, his colleagues noticed that he seemed “very tense,” “depressed,” and “disturbed.” That spring, his depression became severe and his anxiety rose; he couldn’t work. Most alarmingly, as his wife reported, he spent his days walking around the house “shrieking.” “Oh! Lord, lift up my soul,” he would moan loudly. “Today, this is the end of everything, this is the end of everything. I shouldn’t have let myself go.” Feeling “very strongly that he was losing control of himself,” he sought an emergency consultation with Dr. Lee, who recommended that he return to the hospital. On May 5, 1953, he was admitted to McLean for the third time in five years.

  During his psychiatric exam upon admission, he was terribly anxious, and his sense of shame about his anxiety and depression was palpable.o By now he had developed symptoms of what would today be called obsessive-compulsive disorder: he washed his hands constantly, and he shaved and changed shirts multiple times a day.

  Because testosterone injections seemed to have relieved his depression during his earlier stints at McLean, the doctors started him on a large dose. This time, however, “the sense of well-being engendered by the testosterone” could not overcome his symptoms. His psychiatrists judged that talk therapy and drugs would be insufficient to elevate his mood.

  And so, on May 19, with his ready acquiescence, Chester Hanford underwent his first round of electroshock therapy with Kenneth Tillotson.p During each session, Chester would be sedated and strapped tightly to a bed. Orderlies would attach electrodes to various points on his skin and slip in a mouth guard so he wouldn’t bite off his own tongue. Then a switch would be flipped, and several hundred volts of current would pass through his body, which would twitch and convulse on the bed.

  After each session, he would feel a little confused and have a mild headache—both common symptoms of electroshock. But within a day of his first session, he told his doctors he was feeling considerably better. A few days later, he had his second round of treatment. After that, the nurses on his ward noticed that he seemed “more relaxed, more pleasant, and more outgoing.” He stopped ruminating about his problems. He seemed markedly less anxious. A week later, after a third round of electroshock, the transformation was profound: he “looked well,” was sleeping and eating, and was “laughing a great deal.” The nurses reported him to be “much less fearful than when he came in,” no longer “running around asking the nurses whether he can do this or that.” He began spending a great deal of time in the gym with other patients, playing badminton and bowling—activities that he had earlier implied to his psychiatrist were beneath the dignity of a sixty-two-year-old Harvard professor. The electroshock therapy, it seemed, had restored (or injected) a sense of fun.

  After a fourth round of treatment, on June 2, he reported himself “relaxed” and eager to return to work. His wife, who visited him frequently, was amazed: her husband was, she told his psychiatrists, “more the way he was many years ago.” Chester himself told the staff that he felt “more like himself.” To me this sounds uncannily like what Peter Kramer reported in Listening to Prozac: that the patients he put on Prozac in the 1990s had told him the medication made them feel “more like themselves.”

  We still have remarkably little understanding of how electroshock therapy works. Metaphorically, electroshock seems to function the way hitting Ctrl+Alt+Delete on your computer does; it reboots the system, restoring the settings on the neural operating system. The outcome statistics are compelling. Though the practice went out of vogue in the 1970s and 1980s—in part because Jack Nicholson’s portrayal of an electroshock patient in the movie version of Ken Kesey’s novel One Flew over the Cuckoo’s Nest convinced people the technique was barbaric—modern studies show that the recovery rates from severe depression may be higher with electroshock than with any kind of drug or talk therapy. The experience of my great-grandfather, at least in the short term, would seem to bear that out.

  Could there be any more compelling evidence that anxiety and depression are irreducibly “embodied” or “enmattered,” in the fashion observed since Aristotle? By his third trip to the psychiatric hospital, Chester Hanford’s psychiatrists seem largely to have given up on talking or psychoanalyzing him out of his depression and anxiety; his personality and character seemed so fixed as to resist “adjustment.” But zapping his brain with a few hundred volts of electricity, on the other hand—rewiring the connections—seemed to do the trick just fine. After four electroshock treatments, the hospital director wrote that Chester “showed tremendous improvement.”

  On June 9, 1953, about a month after entering the hospital, a cheerful Chester was discharged into the care of his wife. They promptly left for vacation in Maine, where for the first time in years he eagerly anticipated the arrival of the fall semester and a new crop of students to teach.

  I wish Chester Hanford’s story ended on this hopeful note. But in time his anxiety returned, and he was compelled to retire. Throughout the 1950s and 1960s, he went regularly to McLean—and, later, to the New England Deaconess Hospital in downtown Boston—for more electroshock therapy. At one point, a too-potent drug cocktail nearly killed him. For a period in the late 1950s, his anxieties and compulsions got so bad that his doctors considered performing a prefrontal leucotomy—a partial lobotomy. (Ultimately, he was spared.)

  For the balance of his lifetime, he kind of limped along. He would be okay for stretches—and then for stretches he wouldn’t be. Even when he wasn’t okay, he could pull himself together for appearance’s sake. My mother recalls a summer day in the mid-1960s when a party was planned at the Hanford home in western Massachusetts. Family and friends from all over New England were to be gathering that evening. Throughout the day of the party, a haunted moaning emanated from Chester’s bedroom; my mother cringed to think what
his appearance at the party would be like—if he could manage an appearance at all. Yet as twilight fell and the party began, he emerged downstairs as a gracious, even sociable host. And then the next day he retreated again to his room, to his fetal curl and his moaning.

  My parents recall Chester seeming less anxious and agitated during his years in the nursing home—a fact that my father suspects may be explained by the generous doses of Valium administered there. Benzodiazepines may, finally, have successfully tranquilized his anxiety into submission. Or perhaps being liberated from the stresses of work relaxed him.

  In immersing myself so deeply in the psychopathologies of my great-grandfather, and in identifying rather strongly with them, I—as hypochondriacal and prone to worry as I am—have naturally grown concerned that the hereditary taint will soon reduce me, too, to permanent weeping and shaking in my room.

  When I tell Dr. W. about this, he says, “As you know, I don’t place a lot of stock in genetic determinism.”

  I cite some of the recent studies suggesting a powerful heritable component to anxiety disorders and depression.

  “Okay, but you’re three generations removed from your great-grandfather,” he says. “You share only a fraction of his genes.”

  True enough. And in any case, genes and environment interact in complex ways. “[A genetically] inherited reaction to potential danger may be a boon or a bane,” says Daniel Weinberger, the lead researcher on one of the first SERT gene studies. “It can place us at risk for an anxiety disorder, or in another situation it may provide an adaptive positive attribute such as increased vigilance. We have to remember that anxiety is a complicated multidimensional characteristic of human experience and cannot be predicted by any form of a single gene.”