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

by Scott Stossel

  By the turn of the century, the language and imagery of neurasthenia had permeated deep into American culture. If you yourself didn’t suffer from it, you surely knew people who did. Political rhetoric and religious sermons addressed it; consumer advertisements offered remedies for it. Magazines and newspapers published articles about it. Theodore Dreiser and Henry James populated their novels with neurasthenic characters. The language of neurasthenic distress (“depression,” “panic”) crept into economic discourse. Nervousness, it seemed, had become the default psychological state and cultural condition of modern times. Disrupted by the transformations of the Industrial Revolution and riven by Gilded Age wealth inequality, the United States was rife with levels of anxiety unmatched in human history.

  Or so Beard claimed. But was it really?

  According to the latest figures from the National Institute of Mental Health, some forty million Americans, or about 18 percent of the population, currently suffer from a clinical anxiety disorder. Recent editions of Stress in America, a report produced each year by the American Psychological Association, have found a badly “overstressed nation” in which a majority of Americans describe themselves as “moderately” or “highly” stressed, with significant percentages of them reporting stress-related physical symptoms such as fatigue, headache, stomach troubles, muscle tension, and teeth grinding. Between 2002 and 2006, the number of Americans seeking medical treatment for anxiety increased from 13.4 million to 16.2 million. More Americans seek medical treatment for anxiety than for back pain or migraine headaches.

  Surveys by the Anxiety and Depression Association of America find that nearly half of all Americans report “persistent or excessive anxiety” in their daily work lives. (Other surveys find that three out of four Americans believe there is more workplace stress today than in the past.) A study published in the American Psychologist found that 40 percent more people said they’d felt an impending nervous breakdown in 1996 than had said so in 1957. Twice as many people reported experiencing symptoms of panic attacks in 1995 as in 1980.‖ According to a national survey of incoming freshmen, the anxiety levels of college students are higher today than at any time in the twenty-five-year history of the survey. When Jean Twenge, a professor of psychology at San Diego State University, looked at survey data from fifty thousand children and college students between the 1950s and the 1990s, she found that the average college student in the 1990s was more anxious than 85 percent of students in the 1950s and that “ ‘normal’ schoolchildren in the 1980s reported higher levels of anxiety than child psychiatric patients in the 1950s.” (Robert Leahy, a psychologist at Weill Cornell Medical College, characterized this finding colorfully in Psychology Today: “The average high school kid today has the same level of anxiety as the average psychiatric patient in the 1950s.”) The baby boomers were more anxious than their parents; Generation X was more anxious than the boomers; the millennials are turning out to be more anxious than Generation X.

  Rates of anxiety seem to be increasing all around the world. A World Health Organization survey of eighteen countries concluded that anxiety disorders are now the most common mental illness on earth, once again overtaking depression. Statistics from the National Health Service reveal that British hospitals treated four times as many people for anxiety disorders in 2011 as they did in 2007 while issuing record numbers of tranquilizer prescriptions. A report published by Britain’s Mental Health Foundation in 2009 concluded that a “culture of fear”—marked by a shaky economy and hyperbolic threat-mongering by politicians and the media—had produced “record levels of anxiety” in Great Britain.

  Given the “record levels of anxiety” we seem to be seeing around the world, surely we must today be living in the most anxious age ever—more anxious even than George Beard’s era of neurasthenia.

  How can this be? Economic disruption and recent global recession notwithstanding, we live in an age of unprecedented material affluence. Standards of living in the industrialized West are, on average, higher than ever; life expectancies in the developed world are, for the most part, long and growing. We are much less likely to die an early death than our ancestors were, much less likely to be subjected to the horrors of smallpox, scurvy, pellagra, polio, tuberculosis, rickets, and packs of roving wolves, not to mention the challenges of life without antibiotics, electricity, or indoor plumbing. Life is, in many ways, easier than it used to be. Therefore shouldn’t we be less anxious than we once were?

  Perhaps in some sense the price—and surely, in part, the source—of progress and improvements in material prosperity has been an increase in the average allotment of anxiety. Urbanization, industrialization, the growth of the market economy, increases in geographic and class mobility, the expansion of democratic values and freedoms—all of these trends, on their own and in concert, have contributed to vastly improved material quality of life for millions of people over the last several hundred years. But each of these may also have contributed to rising anxiety.

  Until the Renaissance, there was scarcely any concept of social, political, technological, or any other kind of progress. This lent a kind of resignation to medieval emotional life that may have been adaptive: the sense that things would always be as they were was depressing but also comforting—there was no having to adapt to technological or social change; there were no hopes for a better life in danger of being dashed. While life was dominated by the fear—and expectation—of eternal damnation (one Franciscan preacher in Germany put the odds in favor of damnation for any given soul at a hundred thousand to one), medieval minds were not consumed, as ours are, with the hope of advancement and the fear of decline.

  Today, especially in Western capitalist democracies, we also probably have more choice than ever in history: we are free to choose where to live, whom to court or marry, what line of work to pursue, what personal style to adapt. “The major problem for Americans is that of choice,” the late sociologist Philip Slater wrote in 1970. “Americans are forced into making more choices per day, with fewer ‘givens,’ more ambiguous criteria, less environmental stability, and less social structural support, than any people in history.” Freedom of choice generates great anxiety. Barry Schwartz, a psychologist at Swarthmore College, calls this “the paradox of choice”—the idea that as the freedom to choose increases, so does anxiety.

  Maybe anxiety is, in some sense, a luxury—an emotion we can afford to indulge only when we’re not preoccupied by “real” fear. (Recall that William James made a version of this argument in the 1880s.) Perhaps precisely because medieval Europeans had so many genuine threats to be afraid of (the Black Death, Muslim invaders, famine, dynastic turmoil, constant military conflict, and death, always death, imminently present—the average life expectancy during the Middle Ages was thirty-five years, and one out of every three babies died before reaching the age of five), they were left with little space to be anxious, at least in the sense that Freud, for example, meant neurotic anxiety—anxiety generated from within ourselves about things we don’t really have rational cause to be afraid of. Perhaps the Middle Ages were relatively free of neurotic anxiety because such anxiety was a luxury no one could afford in their brief, difficult lives. In support of this proposition are the surveys showing that people in developing nations have lower rates of clinical anxiety than Americans despite life circumstances that are materially more difficult.

  Moreover, political and cultural life in the Middle Ages was largely organized to minimize, even eliminate, the sorts of social uncertainties we contend with today. “From the moment of birth,” the psychoanalyst and political philosopher Erich Fromm observed, “[the medieval person] was rooted in a structuralized whole, and thus life had a meaning which left no place, and no need, for doubt. A person was identical with his role in society; he was a peasant, an artisan, a knight, and not an individual who happened to have this or that occupation.” One argument for why twenty-first-century life produces so much anxiety is that social and political roles are no long
er understood to have been ordained by God or by nature—we have to choose our roles. Such choices, research shows, are stressful. As sodden with fear and darkness and death as the Middle Ages were, Fromm and others argue, they were likely freer of anxiety than our own time is.

  The “dizziness of freedom,” as Kierkegaard described it, produced by the ability to make choices, can have political implications: it can generate anxiety so intense that it creates a yearning to return to the comforting certainties of the primary ties—a yearning for what Fromm called “the escape from freedom.” Fromm argued that this anxiety led many working-class Germans to willingly submit to Hitler in the 1930s. Paul Tillich, a theologian who grew up in Weimar Germany, similarly explained the rise of Nazism as a response to anxiety. “First of all a feeling of fear or, more exactly, of indefinite anxiety was prevailing,” he writes of 1930s Germany. “Not only the economic and political, but also the cultural and religious, security seemed to be lost. There was nothing on which one could build; everything was without foundation. A catastrophic breakdown was expected every moment. Consequently, a longing for security was growing in everybody. A freedom that leads to fear and anxiety has lost its value; better authority with security than freedom with fear.” Herbert L. Matthews, a New York Times correspondent who covered Europe between the wars, also observed that Nazism provided relief from anxiety: “Fascism was like a jail where the individual had a certain amount of security, shelter, and daily food.” Arthur Schlesinger, Jr., writing a few years after the end of the Second World War, observed the same thing about Soviet Communism: “It has filled the ‘vacuum of faith’ caused by the waning of established religion; it provides the sense of purpose which heals internal agonies of anxiety and doubt.” In periods of social disruption, when old verities no longer obtain, there’s a danger that, as Rollo May put it, “people grasp at political authoritarianism in their desperate need for relief from anxiety.”

  One implication of the neurobiologist Robert Sapolsky’s work is that human social and political systems that are highly fluid and dynamic generate more anxiety than systems that are static. Sapolsky points out that “for 99 percent of human history” society was “most probably strikingly unhierarchical” and therefore probably less psychologically stressful than in the modern era. For hundreds of thousands of years, the standard form of human social organization was the hunter-gatherer tribe—and such tribes were, judging from what we know of the bands of hunter-gatherers that still exist today, “remarkably egalitarian.” Sapolsky goes so far as to say that the invention of agriculture, a relatively recent development in the scope of human history, “was one of the great stupid moves of all times” because it allowed for the stockpiling of food and, for the first time in history, “the stratification of society and the invention of classes.” Stratification created relative poverty, making possible the invidious comparison and producing the occasion for status anxiety.

  Jerome Kagan, among others, has argued that historical changes in the nature of human society have led to mismatches between our evolutionary hardwiring and what modern culture values. Qualities such as excessive timidity, caution, and concern with the opinions of others that would have been socially adaptive in early human communities are much “less adaptive in an increasingly competitive, mobile, industrialized, urban society than these traits had been several centuries earlier in a rural, agricultural economy of villages and towns,” Kagan writes. In preliterate cultures, all members of a community generally shared the same values and sources of meaning. But starting sometime around the fifth century B.C., humans have increasingly lived in communities of strangers with diverse values—a trend that hyperaccelerated during the Renaissance and again during the Industrial Revolution. As a result, and especially since the Middle Ages, “a different kind of uncomfortable feeling was evoked by reflection on the adequacy of self’s skills or status and the validity of one’s moral premises,” Kagan argues. “These feelings, which were labeled anxiety, ascended to the position of the alpha emotion in the hierarchy of human affects.” Perhaps the human organism is not equipped to live life as society has lately designed it—a harsh zero-sum competition where the only gains to be had are at the expense of someone else, where “neurotic competition” has displaced solidarity and cooperation. “Competitive individualism militates against the experience of community, and the lack of community is a centrally important factor in contemporaneous anxiety,” Rollo May argued in 1950.

  By 1948, when W. H. Auden won the Pulitzer Prize for The Age of Anxiety, his six-part poem depicting man adrift (“as unattached as tumbleweeds”) in an uncertain industrial world, anxiety seemed to have leached out of the realm of psychiatry to become a general cultural condition. During the 1950s, with America newly ascendant after the Second World War, the best-seller list was already stippled with books about how to achieve nervous relief. On the heels of Dale Carnegie’s best-selling 1948 How to Stop Worrying and Start Living came a passel of books bearing titles like Relax and Live and How to Control Worry and Cure Your Nerves Yourself and The Conquest of Fatigue and Fear, suggesting that America was in the grip of what one social historian called “a national nervous breakdown.” On March 31, 1961, a Time magazine cover story (featuring an image of Edvard Munch’s The Scream) declared that the present era “is almost universally regarded as the Age of Anxiety.” The British and American best-seller lists of the 1930s, a much more unstable time, were similarly populated with self-help books about “tension” and “nerves.” Conquest of Nerves: The Inspiring Record of a Personal Triumph over Neurasthenia went through multiple printings in 1933 and 1934. You Must Relax: A Practical Method of Reducing the Strains of Modern Living, a book by an American physician named Edmund Jacobson, reached the top of the New York Times best-seller list in 1934.

  In linking anxiety to uncertainty, Auden was both falling into a long historical tradition and anticipating modern neuroscience. One of the earliest uses of the word “anxiety” in English associated it with chronic uncertainty: the seventeenth-century British physician and poet Richard Flecknoe wrote that the anxious person “troubles herself with every thing” or is “an irresolute person” who “hovers in his every choice like an empty Ballance with no weight of Judgment to incline him to either scale.… When he begins to deliberate he never makes an end.” (The first among the Oxford English Dictionary’s definitions of “anxiety” is “uneasiness about some uncertain event” [emphasis added].) Recent neurobiological investigations have revealed that uncertainty activates the anxiety circuits of the brain; the amygdalae of clinically anxious people are unusually sensitive to uncertainty. “Intolerance of uncertainty appears to be the central process involved in high levels of worry,” Michel J. Dugas, a psychologist at Penn State, has written. Patients with generalized anxiety disorder “are highly intolerant of uncertainty,” he says. “I use the metaphor of ‘allergy’ to uncertainty … to help them conceptualize their relationship with uncertainty.” Between 2007 and 2010, there was a 31 percent increase in the number of news articles employing the word “uncertainty.” No wonder we’re so anxious.

  Except maybe we’re relatively less anxious than we think. Because if you read far enough back into the cultural history of nervousness and melancholy, each successive generation’s claim to be the most anxious starts to sound much like the claims of the generations that preceded and followed it. When the British physician Edwin Lee, writing in A Treatise on Some Nervous Disorders in 1838, argued that “nervous complaints prevail at the present day to an extent unknown at any former period, or in any other nation,” he sounds not only like George Miller Beard after him but also like the British naval surgeon Thomas Trotter before him. “At the beginning of the nineteenth century, we do not hesitate to affirm that nervous disorders … may now be justly reckoned two thirds of the whole with which civilized society is afflicted,” Trotter wrote in A View of the Nervous Temperament, published in 1807.a Eighty years before Trotter, George Cheyne, the most prominent �
�nerve doctor” of his day, argued that the “atrocious and frightful symptoms” of the nervous affliction he had dubbed “the English Malady” were “scarce known to our ancestors, and never r[ose] to such fatal heights nor afflict[ed] such numbers and any other known nation.”b

  Some intellectual historians have traced the birth of modern anxiety to the work of the seventeenth-century Oxford scholar Robert Burton.c Burton was not a doctor, and he scarcely left his study, so busy was he for dozens of years reading astonishingly widely and scribbling away at his mammoth tome, The Anatomy of Melancholy, but his influence on Western literature and psychology has been lasting. Sir William Osler, the inventor of the medical residency system and one of the most influential doctors of the late nineteenth century, called The Anatomy of Melancholy “the greatest medical treatise ever written by a layman.” John Keats, Charles Lamb, and Samuel Taylor Coleridge all treasured it and drew on it for their own work. Samuel Johnson, for his part, told James Boswell that it was “the only book that ever took him out of bed two hours sooner than he wished to rise.” Completed in 1621, when Burton was forty-four and then revised and expanded multiple times over the following seventeen years, The Anatomy of Melancholy is an epic work of synthesis that ranges across all of history, literature, philosophy, science, and theology up to that time. Originally published in three volumes, the work swelled as Burton tinkered and added (and added some more) in the years before his death in 1640; my own copy, a paperback facsimile of the sixth edition, is 1,382 pages of very small type.