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

by Scott Stossel

  Much of what Burton writes is absurd, nonsensical, self-contradictory, boring, in Latin, or all of the above. But it is also full of good humor and dark pessimism and consoling wisdom about the human condition (it’s easy to see why Samuel Johnson was so taken with it), and in his exuberant travels through what seems like everything ever written, he managed to gather all of the extant human knowledge about melancholy in a single work and to establish for later writers and thinkers the terrain on which they would operate. The work is also clearly informed by his own depression and, like Augustine’s Confessions and Freud’s Interpretation of Dreams, draws insight not only from the expert testimony of others but from his own deep introspection. “Other men get their knowledge from books,” he writes. “I get mine from melancholizing.” Of course, a lot of Burton’s knowledge does come from books—he cites thousands of them—and part of what makes the book so interesting is Burton’s ability to objectify his subjective experience.d

  Though parts of Burton’s book were already outdated and ridiculous when he published it, some of his insights and observations are quite modern. His clinically precise description of a panic attack would pass muster with the DSM-V: “Many lamentable effects this fear causeth in men, as to be red, pale, tremble, sweat; it makes sudden cold and heat to come over all the body, palpitation of the heart, syncope, etc.” And here’s a passable description of what would today be diagnosed as generalized anxiety disorder: “Many men are so amazed and astonished with fear, they know not where they are, what they say, what they do, and that which is worst, it tortures them many days before with continual affrights and suspicion. It hinders most honourable attempts, and makes their hearts ache, sad and heavy. They that live in fear are never free, resolute, secure, never merry, but in continual pain: that, as Vives truly said, Nulla est miseria major quam metus, no greater misery, no rack, nor torture like unto it; ever suspicious, anxious, solicitous, they are childishly drooping without reason, without judgment, ‘especially if some terrible object be offered,’ as Plutarch hath it.”e

  Burton piles up hundreds upon hundreds of theories about anxiety and depression, many of which contradict each other, but in the end the treatments he emphasizes might be boiled down to getting regular exercise, playing chess, taking baths, reading books, listening to music, using laxatives, eating right, practicing sexual moderation, and, above all, keeping busy. “There is no greater cause of melancholy than idleness, ‘no better cure than business,’ ” he wrote, citing the Arabian physician Rhasis. Channeling the wisdom of the Epicureans and the Stoics (and, from the East, the Buddhists), he advises modesty of ambition and an acceptance of what one has as a path to happiness: “If men would attempt no more than what they can bear, they should lead contented lives and, learning to know themselves, would limit their ambition; they would perceive then that nature hath enough without seeking such superfluities and unprofitable things, which bring nothing with them but grief and molestation. As a fat body is more subject to diseases, so are rich men to absurdities and fooleries, to many casualties and cross inconveniences.”

  Trying to directly compare levels of anxiety between eras is a fool’s errand. Modern poll data and statistics about rising and falling levels of tranquilizer consumption aside, there is no magical anxiety meter that can transcend the cultural particularities of place and time to objectively measure levels of anxiety—which, like any emotion, is in some sense an inherently subjective and culturally bound thing. But if anxiety is a descendant of fear, and if fear is an evolutionary impulse designed to help prolong the survival of the species, then anxiety is surely as old as the human race. Humans have always and ever been anxious (even if that anxiety gets refracted in different ways in different cultures); some relatively fixed proportion of us have always been more anxious than others. As soon as the human brain became capable of apprehending the future, it became capable of being apprehensive about the future. The ability to plan, the ability to imagine the future—with these come the ability to worry, to dread the future. Did Cro-Magnons suffer nervous stomachs when predators lurked outside the cave? Did early hominids find their palms getting sweaty and their mouths dry when interacting with higher-status members of the tribe? Were there agoraphobic cavemen or Neanderthals who endured performance anxiety or fear of heights? I imagine there were, since these proto–Homo sapiens were the products of the same evolution that has generated our own capacity for anxiety, and they possessed the same, or very similar, physiological equipment for fear.

  Which suggests that anxiety is an abiding part of the human condition. “In our day we still see our major threats as coming from the tooth and claw of physical enemies when they are actually largely psychological and in the broadest sense spiritual—that is they deal with meaninglessness,” Rollo May wrote in 1977 in the foreword to his revised edition of The Meaning of Anxiety. “We are no longer prey to tigers and mastodons but to damage to our self-esteem, ostracism by our group, or the threat of losing out in the competitive struggle. The form of anxiety has changed, but the experience remains relatively the same.”

  * * *

  * Anxiety seems to be woven into the American spirit—as Alexis de Tocqueville observed as early as the 1830s. “Life would have no relish for the [people who live in democracies] if they were delivered from the anxieties which harass them, and they show more attachment to their cares than aristocratic nations to their pleasures,” he wrote in Democracy in America.

  † It also produced drug dependence. Just as the postwar affluence of the 1950s would lead to the frantic gobbling of Miltown, Librium, and Valium, the competitive pressures of the late nineteenth century produced an alarming rise in the number of “opiate eaters.” Writing in Confessions of an American Opium Eater: From Bondage to Freedom in 1895, Henry G. Cole argued that “our mechanical inventions, the spread of our commerce … our ambition for political honors; and grasping for petty offices for gain; our mad race for speedy wealth, which entails feverish excitements … [and] a growth so rapid, and in some ways so abnormal, [have combined to produce] the mental strain [that] has been too much for the physical system to bear; till finally, the overworked body and the overtaxed body must … find rest in the repeated use of opium or morphine.”

  ‡ Elsewhere, Beard wrote that anxiety was “modern, and originally American; and no age, no country, and no form of civilization, not Greece, not Rome, nor Spain, nor the Netherlands, in their days of glory, possessed such maladies.”

  § Some years earlier, the elites of Georgian Britain—the period extending from the early 1700s until Queen Victoria ascended to the throne in 1837—had adopted a similar “nervous culture,” which claimed for itself the same kind of self-flattering class connotations that would be characteristic of American neurasthenia: the idea that the nervous systems of those of better breeding and more creative sensibilities were unusually susceptible to hypochondriasis and nervous collapse. This culture, like that of the Renaissance, tended to glamorize individuals with sensitive nervous systems while providing both medical and psychological explanations for their delicate constitutions. As anatomists continued to unlock the secrets of the human nervous system, scientists of this era variously described the nerve network as a system of fibers, strings, pipes, and cords, venturing explanations that attributed the system’s functioning to hydraulics, electricity, mechanics, and so forth. The crucial concept in all these explanations was the nervous breakdown—the idea being that when the nervous system was overstrained, it would break down, producing both mental and physical symptoms and often general prostration. Beginning in the 1730s, the malfunctions of the nervous system that led to breakdown were often called “nervous distempers,” which encompassed everything from hysteria and hypochondria to “the vapors”—mental and physical complaints that in more recent times would be labeled psychoneurotic or psychosomatic.

  In striking contrast to the stiff-upper-lip ideals of the Victorian era that would follow, the British elites of the eighteenth century wal
lowed in, and even cultivated, their nervous disabilities. “Nervous self-fashioning”—painting oneself as the victim of one’s nerves—was common. From 1777 to 1783, James Boswell, Samuel Johnson’s biographer, wrote a monthly essay for The London Magazine under the pen name the Hypochondriack, and in his own diary he minutely tracked every subtle shift in his endless litany of emotional and physical symptoms. Boswell was obsessed with his digestive system. “From this day follow Mr. [John] Locke’s prescription of going to stool every day regularly after breakfast,” he wrote in his journal early in October 1764. “It will do your health good, and it is highly necessary to take care of your health.” (Yes, that John Locke—the one who wrote Two Treatises of Government and is the father of constitutional liberalism. Most people turn to Locke for his thoughts on political philosophy; Boswell did so for his advice on digestive hygiene. If you’re curious what Locke’s prescription was, well, so was I—so I tracked it down, and here’s what I found in section 24 of Some Thoughts Concerning Education: “If a man, after his first eating in the morning, would presently solicit nature, and try whether he could strain himself so as to obtain a stool, he might in time, by constant application, bring it to be habitual.”)

  Nervous disorders of various kinds were believed to be so widespread during this time that, despite the various physiological explanations given for them, they were viewed as a cultural condition as much as a medical one. One prominent British physician claimed that a third of the population was “destroyed or made miserable by the Diseases.” (The popularity of nervous illness during this time was not confined to England. In 1758, Joseph Raulin, the personal physician to Louis XV of France, wrote that “the vapors” had become “a veritable social plague, an endemic disease in the cities [of the Continent].”)

  ‖ This is not surprising, considering that panic attacks did not officially exist until the publication of the DSM-III in 1980.

  a Trotter warned that an “epidemic” of nervousness threatened not only the “national character” of Britain but also its national security, since in their weakened states, British citizens were ripe for being invaded and conquered. (Trotter’s fears about the country’s epidemic of nervous weakness were intensified by Napoleon, who was marauding around the Continent.)

  b Cheyne claimed that a third of the British population was afflicted with the nervous condition known variously as “spleen,” “the vapours,” or “hypochondria”—what would today be clustered in the DSM under the umbrellas of the anxiety or depressive disorders. (Note that Cheyne is claiming a level of anxious affliction for the England of the 1730s that is comparable to what the National Institute of Mental Health claims for America today.)

  c Citing the reports of other writers, Burton claimed that the frequency of melancholia—which subsumed the modern diagnoses of both anxiety and depression—was “so common in this crazed age of ours” that “scarce one in a thousand is free from it.”

  d I feel a kinship with Burton because he freely conceded that he wrote about melancholy to combat his own: “I write of melancholy, by being busy to avoid melancholy.” (I write of anxiety to avoid being anxious.)

  e Plutarch, the biographer and historian, described vividly and accurately how what we would today call clinical depression can bring with it an escalation of anxiety. Anyone who has suffered the torturous insomnia of agitated depression—where anxiety begets sleeplessness and sleeplessness begets more anxiety—will recognize the clinical aptness of Plutarch’s description. To the depressed person, he writes, “every little evil is magnified by the scaring spectres of his anxiety.… Asleep or awake he is haunted alike by the spectres of his anxiety. Awake, he makes no use of his reason; and asleep, he enjoys no respite from his alarms. His reason always slumbers; his fears are always awake. Nowhere can he find an escape from his imaginary terrors.”

  Plutarch was not a physician—but Galen, born not long after Plutarch died, was. Describing an epidemic of anxiety that sounds remarkably modern, Galen wrote of having seen “tremors in the hearts of healthy young people and adolescents weak and thin from anxiety and depression” and patients with “scarce, turbulent, and interrupted sleep, palpitations, vertigo” and “sadness, anxiety, diffidence, and the belief of being persecuted.”

  PART V

  Redemption and Resilience

  CHAPTER 11

  Redemption

  The capacity to bear anxiety is important for the individual’s self-realization and for his conquest of his environment.… Self-actualization occurs only at the price of moving ahead despite such shocks. This indicates the constructive use of anxiety.

  —KURT GOLDSTEIN, Human Nature in the Light of Psychopathology (1940)

  Starting when I was ten years old, I saw the same psychiatrist once or twice a week for twenty-five years. Dr. L. was the psychiatrist who, when I was taken to McLean Hospital as a comprehensively phobic ten-year-old, administered my Rorschach test. When I started therapy with him in the early 1980s, he was approaching fifty, tall and lanky, balding a little, with a beard in the classic Freudian style. Over the years, the beard came and went a few times, and he lost more of his hair, which turned, over time, from brown to salt-and-pepper to white. He moved his office from one place (where he lived with his first wife) to another (where he lived with his second wife) to a third (where he leased space from an eye doctor) to a fourth (where, in keeping with his migration in a New Age direction, he shared a waiting room with a massage therapist and an electrologist) to, finally, the last time I visited him, a building by the ocean on Cape Cod (where he’d moved his practice and where his office is once again connected to his house).

  Trained at Harvard in the 1950s and early 1960s, Dr. L. came of professional age in the late stages of the psychoanalytic heyday, when Freudianism still dominated. When I first encountered Dr. L., he was a believer both in medication and in such Freudian concepts as neurosis and repression, Oedipus complexes and transference. Our first sessions, in the early 1980s, were filled with Rorschach tests and free-associating and discussions of early memories from my youngest years. Our last sessions, in the mid-2000s, were focused on role-playing and “energy work”; he also spent a lot of time during those latter years trying to get me to sign up for a special kind of yoga program that is today defending itself in federal court against multiple allegations that it is a brainwashing cult.

  Here’s some of what we did in our sessions together over a quarter century: looked at picture books (1981); played backgammon (1982–85); played darts (1985–88); experimented sporadically with various cutting-edge psychotherapeutic methods of a progressively more New Age complexion, such as hypnotism, facilitated communication, eye movement desensitization and reprocessing, inner-child therapy, energy systems therapy, and internal family systems therapy (1988–2004). I was the beneficiary, or possibly the victim, of seemingly every passing trend in psychotherapy and psychopharmacology.

  A few years ago, when embarking on the research for this book, I decided to track down Dr. L. for an interview. His inability to cure me notwithstanding, who better to help me figure out my anxiety than the man who had worked for decades to treat me? So I wrote to him to tell him what I was working on and to ask if I might interview him about my many years of therapy with him and look at any old case files of mine he still had. He said he didn’t have my files anymore but that he would be happy to talk. So on a cold afternoon in late November, I drove from Boston out the length of Cape Cod to Provincetown, brisk and barren in the off-season. It had been more than five years since I’d last seen or spoken to him, and I was anxious (of course) about how the meeting would go. Wanting to maintain a journalistic composure—and to avoid falling into old dependent habits of relating to him (he’d been a father figure for twenty-five years)—I popped a Xanax beforehand and briefly considered stopping at a liquor store for a sedating nip of vodka.* I pulled into his driveway in the midafternoon.

  Waiting on his back deck, he waved and gestured me up the steps and into
his office, where he greeted me warmly, if a little warily, wondering, I suspect, if I had come to gather evidence for a malpractice suit. (His e-mail correspondence leading up to this meeting, about my case files and so forth, had all seemed carefully worded, as though vetted by a lawyer.) By then in his late seventies, he still looked lithe and fit and appeared younger than his years. We sat down and I caught him up on what I’d been doing the past few years, and then we began talking about my anxiety.

  What, I asked, did he remember about my case from when I originally showed up at the psychiatric hospital more than two decades earlier?

  “I remember it pretty clearly,” he said. “You were a very distressed child.”

  I asked him about my emetophobia, which had already presented itself forcefully by the time I was ten. “It was a dramatic fantasy that vomiting would make your body come apart,” he said. “Your parents didn’t help you to reality-test, and you merged with that phobia.”