Did he remember how he and the team at the mental hospital interpreted my Rorschach test? I had recently approached the records department at McLean Hospital to ask whether archivists could find my original evaluation file, but it had been moved off-site some years ago, and no one had been able to track it down. The only image I could recall was one that I remembered looking like a wounded bat, its wings torn, unable to escape from its cave. “That likely had something to do with your feelings of being abandoned or being enveloped,” Dr. L. said. “A sense of lack of safety and of enormous vulnerability.”
I asked him what he thought had produced that vulnerability.
“There was a whole host of causal factors. We knew there were deficits in the parents.”
He spoke first about my father, whom he knew very well, having counseled him when my mother left him for the managing partner of her law firm.† “When you were growing up, your father had a very strong ‘knower,’ which meant that parts of himself stood strongly in judgment. He didn’t have a lot of tolerance for anxious behavior. Your anxiety would make him blow up with anger. He had no empathy. When you got anxious, he would judge it and want to fix it. He couldn’t just help you sit with it. He couldn’t soothe you.”
Dr. L. paused for a moment. “He couldn’t soothe himself, either. He would judge his anxiety. In his mind, anxiety is weakness. It makes him angry.”‡
What about my mother?
“She was too anxious herself to be very effective at helping you cope with your own anxiety,” Dr. L. said. “She organized her life around trying not to be anxious. So when you got anxious, she would get anxious. A parent-child unit like that, the child takes on the anxiety of the parent but doesn’t know where it came from. Her anxiety became yours, and you couldn’t handle it, and she couldn’t help you.
“You had problems with ‘object constancy,’ ” he continued. “You couldn’t carry an internal image of your parents. Whenever you were away from them, you were in fundamental doubt about whether you were being abandoned. Your parents could never settle down enough to give you the assurance they were on the planet.”§
Dr. L. said he believed this separation anxiety was compounded by my mother’s overprotectiveness. “The message you got from your mother was, You can’t take it—don’t take risks because the anxiety will be too overwhelming.”
I tell him it sounds like he’s mainly attributing my anxiety to psychodynamic issues—to the relationship I had with my parents. But doesn’t modern research suggest that vulnerability to anxiety is largely genetic? Doesn’t, for instance, Jerome Kagan’s work on the links between genes and temperament, and between temperament and anxiety, suggest that anxious character is hardwired into the genome?
“Look, maybe having an ‘inhibited temperament’ made things worse for you,” he said. “But my own view is that even if you hadn’t had that kind of genetically produced temperament, your mother’s personality might still have given you issues. Neither she nor your father could offer what you needed. You couldn’t soothe yourself.
“Yes,” he continued, “there’s evidence that you’ve got neurochemical problems produced by your genes. And your mother’s personality was a bad match for your genetic temperament. But a gene predisposing you to an illness doesn’t necessarily give you that illness. Geneticists say, ‘We’ll map the genes and find out the trouble.’ No! Not true! Even with breast cancer, sometimes only an environmental factor—like nutrition—will catalyze a genetic predisposition to cancer into actual cancer.”
I observe that medication—Xanax, Klonopin, Celexa, alcohol—is more effective at soothing me than my parents ever were, or than Dr. L. was, or than my own self-will (whatever that may consist of) is. Doesn’t that suggest that my anxiety is a medical problem more than a psychological one, regardless of what my parents’ shortcomings may have been? That anxiety is a problem embedded in the body, in the physical brain rather than some disembodied mind or psyche—a problem that leaches up from body to brain to mind rather than seeping down from mind to brain to body?
“False dichotomy!” he says emphatically, standing up to pull a book off his shelf: Descartes’ Error. In it, the neurologist Antonio Damasio explains that Descartes was wrong to argue that the mind and body are distinct. The mind-body duality is not in fact a duality, Dr. L. says, paraphrasing Damasio. The body gives rise to the mind; the mind imbues the body. The two cannot be differentiated. “Neocortical function”—that is, the mind—“makes us who we are,” Dr. L. says. “But the limbic system”—which is autonomic and unconscious—“may be just as relevant, if not more, in determining who we are. The neocortex can’t make a decision without the emotional system playing in.”
To illustrate the inseparability of body and mind, Dr. L. talked about the effects of trauma. (He had recently been to Sri Lanka, where he coached psychotherapists on how to work with survivors of the 2004 tsunami.) The experience of trauma or abuse, he explained, gets stored in the body, “woven into the bodily tissue.”
“Consider Holocaust survivors,” he said. “Even grandkids of Holocaust survivors carry extra anxiety that is measurable at a physiological level. They tend to have more anxious triggers. If they see a movie with victims of violence in Somalia, they respond to it much more strongly.” This is true, he said, not just of the children of Holocaust survivors but of their grandchildren and even great-grandchildren. “They’ve got something plastered into their bodies via the experience of their parents or grandparents. The trauma doesn’t even belong to them, but it affects them.” (I think here of my father’s Holocaust fixation, the books about Nazis piled always on his bedside table, the World War II documentaries always running on the TV. His mother and father had escaped Germany before the Holocaust; so did much of the rest of the family, but not before his uncles and grandfather were beaten up on Kristallnacht.)
I asked Dr. L. how much he thought the psychiatric field had changed since he entered it nearly fifty years ago, especially regarding its thinking about the causes and treatment of anxiety.
“Freudians were about ‘insight’ über alles,” he said. “If you had insight about your neurosis, the expectation was that you could control it. Wrong!”
Dr. L.’s treatments of choice these days are, depending on your point of view, either high-tech and cutting-edge or New Age and weird: for instance, eye movement desensitization and reprocessing, which involves moving your eyes back and forth while reliving a trauma, and internal family systems therapy, based on the work of the psychiatrist Richard Schwartz, which involves training a patient to gain control of his multiple selves through the “conducting self” and helping him to develop a better, more strengthening relationship with his vulnerable inner child. In my latter years of therapy with Dr. L., I spent a lot of time moving from chair to chair in his office, inhabiting different “selves” and “energies,” and talking to my inner child.
“We used to have a monolithic view of mood and personality disorders,” Dr. L. continued. “But now we realize we have little packets of personality; they have their own sets of beliefs and values.” The key to treatment, he says, is to make the patient conscious of these multiple selves and to help him manage the selves that carry trauma or anxiety.
“Today,” he said, “we now know much more about the neurocircuitry of anxiety. Sometimes you need to medicate. But newer, better psychiatry alters the brain chemistry—alters it in the same way drugs do.”
“Am I doomed by my neurocircuitry?” I asked. “I went to therapy with you for twenty-five years, and have seen multiple other therapists, and have tried multiple methods of treatment. And yet here I am, advancing into middle age, and still suffering from chronic and often debilitating anxiety.”
“No, you’re not doomed,” Dr. L. said. “We now know enough about neuroplasticity to understand that the circuitry is always growing. You can always modify the software.”
Even if I can’t fully recover from my anxiety, I’ve come to believe there may be so
me redeeming value in it.
Historical evidence suggests that anxiety can be allied to artistic and creative genius. The literary gifts of Emily Dickinson, for example, were inextricably bound up with her anxiety. (She was completely housebound, and in fact rarely left her bedroom, after age forty.) Franz Kafka yoked his neurotic sensibility to his artistic sensibility; so, of course, did Woody Allen. Jerome Kagan, the Harvard psychologist, argues that T. S. Eliot’s anxiety and high-reactive physiology helped make him a great poet. Eliot was, Kagan observes, a “shy, cautious, sensitive child”—but because he also had a supportive family, good schooling, and “unusual verbal abilities,” Eliot was able to “exploit his temperament” to become an outstanding poet.
Perhaps most famously, Marcel Proust transmuted his neurotic sensibility into art. Marcel’s father, Adrien, was a physician specializing in nervous health and the author of an influential book called The Hygiene of the Neurasthenic. Marcel read his father’s work, as well as books by many of the other leading nerve doctors of his day, and incorporated their work into his; his fiction and nonfiction are “saturated with the vocabulary of nervous dysfunction,” as one critic has put it. At various points throughout Remembrance of Things Past, characters either comment on or embody the idea that, as Aristotle first observed, nervous suffering can give rise to great art. For Proust, refinement of artistic sensibility was directly tied to a nervous disposition. From the high-strung comes high art.‖
From the high-strung can also come, at least some of the time, great science. Dean Simonton, a psychologist at the University of California, Davis, who has spent decades studying the psychology of genius, estimates that a third of all eminent scientists suffer from anxiety or depression or both. He surmises that the same cognitive or neurobiological mechanisms that predispose certain people to developing anxiety disorders also enhance the sort of creative thinking that produces conceptual breakthroughs in science. When Sir Isaac Newton invented calculus, no one knew about it for ten years—because he was too anxious and depressed to tell anyone. (For several years, he was too agoraphobic to leave his house.) Perhaps if Darwin had not been forcibly housebound by his anxiety for decades on end, he would never have been able to finish his work on evolution. Sigmund Freud’s career was nearly derailed early on by his terrible anxiety and self-doubt; he overcame it to become a cult figure and a major intellectual influence on generations of psychotherapists. Once his reputation as a great man of science had been established, Freud and his acolytes sought to engrave in stone the image of him as the eternally self-assured wise man. But his early letters reveal otherwise.a
No, anxiety is not, by itself, going to make you a Nobel Prize–winning poet or a groundbreaking scientist. But if you harness your anxious temperament correctly, it might make you a better worker. Jerome Kagan, who has spent more than sixty years studying people with anxious temperaments, believes that anxious employees are better employees. In fact, he says, he learned to hire only people with high-reactive temperaments as research assistants. “They’re compulsive, they don’t make errors, they’re careful when they’re coding data,” he told The New York Times. They “are generally conscientious and almost obsessively well-prepared.” Assuming they can avoid succumbing to full-blown anxiety disorders, “worriers are likely to be the most thorough workers and the most attentive friends,” as The Times put it. Other research supports Kagan’s observation. A 2012 study by psychiatrists at the University of Rochester Medical Center found that conscientious people who were highly neurotic tended to be more reflective, more goal oriented, more organized, and better at planning than average; they tended to be effective, “high-functioning” workers—and to be better at taking care of their physical health than other workers. (“These people are likely to weigh the consequences of their actions,” Nicholas Turiano, the lead researcher, said. “Their level of neuroticism coupled with conscientiousness probably stops them from engaging in risky behaviors.”) A 2013 study in the Academy of Management Journal found that neurotics contribute more than managers predicted to group projects, while extroverts contribute less, with the contributions of the neurotics becoming even more valuable over time. The director of the study, Corinne Bendersky, an associate professor at UCLA’s Anderson School of Management, says that if she were staffing a team for a group project, “I would staff it with more neurotics and fewer extroverts than my initial instinct would lead me to do.” In 2005 researchers at the University of Wales published a paper, “Can Worriers Be Winners?,” reporting that financial managers high in anxiety tended to be the best, most effective money managers, as long as their worrying was accompanied by high IQs. Smart people who worry a lot, the researchers concluded, tend to produce the best results.b
Unfortunately, the positive correlation between worrying and job performance disappeared when the worriers had low IQs. But some evidence suggests that excessive worrying is itself allied to high IQ. Dr. W. says that his anxious patients tend to be his smartest patients. (In his experience, anxious lawyers have tended to be particularly smart—skilled not only at foreseeing complex legal eventualities but also at imagining worst-case scenarios for themselves.) Dr. W.’s anecdotal observations are supported by recent scientific data. Some studies have found the correlation to be quite direct: the higher your IQ, the more likely you are to worry; the lower your IQ, the less likely you are to worry. A study published in 2012 in Frontiers in Evolutionary Neuroscience found that high IQ scores correlated with high levels of worry in people diagnosed with generalized anxiety disorder. (Anxious people are very smart at plotting out possible bad outcomes.) Jeremy Coplan, the lead author of that study, says that anxiety is evolutionarily adaptive because “every so often there’s a wild-card danger.” When such a danger arises, anxious people are more likely to be prepared to survive. Some people, Coplan says, are effectively stupid enough that they are “incapable of seeing any danger, even when danger is imminent”; moreover, “if these folks are in positions as leaders, they are going to indicate to the general populace that there’s no need to worry.” Coplan, a professor of psychiatry at the State University of New York Downstate Medical Center, says that anxiety can be a good trait in political leaders—and that lack of anxiety can be dangerous. (Some commentators have suggested, based on findings like Coplan’s, that the main cause of the economic crash of 2008 was politicians and financiers who were either stupid or insufficiently anxious or both.)
The correlations aren’t universal, of course: there are plenty of brilliant daredevils and stupid worriers. And, as always, this comes with the proviso that anxiety is productive mainly when it is not so excessive as to be debilitating. But if you are anxious, perhaps you can take heart from the growing collection of evidence suggesting that anxiety and intelligence are linked.
Anxiety may also be tied both to ethical behavior and to effective leadership. My wife once mused aloud about what I might lose if I were to be fully cured of my anxiety—and about what she might lose if I were to lose my anxious temperament.
“I hate your anxiety,” she said, “and I hate that it makes you unhappy. But what if there are things that I love about you that are connected to your anxiety? What if,” she asked, getting to the heart of the matter, “you’re cured of your anxiety and you become a total jerk?”
I suspect I might—because it may be that my anxiety lends me an inhibition and a social sensitivity that make me more attuned to other people and a more tolerable spouse than I otherwise would be. Evidently, fighter pilots have unusually high divorce rates—a fact that may be tied to their having low levels of anxiety and a corresponding low baseline autonomic arousal, which together are tied not only to a need for adventure (indulged by flying a fighter plane or having extramarital affairs) but also to a certain interpersonal obtuseness, a lack of sensitivity to their partners’ subtle social cues.c Anxious people, because they are vigilantly scanning the environment for threats, tend to be more attuned than adrenaline junkies to other people’s emotion
s and social signals.
The notion of a connection between anxiety and morality long predates the findings of modern science or my wife’s intuition. Saint Augustine believed fear was adaptive because it helps people behave morally. (That’s also what both Thomas Burgess and Charles Darwin believed about anxiety and blushing: fear of misbehavior helps primates and humans behave “rightly,” preserving social comity.) The pragmatist philosophers Charles Sanders Peirce and John Dewey believed that the human aversion to experiencing negative emotions like anxiety, shame, and guilt provides a kind of internal psychological incentive to behave ethically. Furthermore, psychological studies of criminals have found them to be low in anxiety, on average, and to have low-reactive amygdalae. (Criminals also tend to have lower-than-average IQs.)
In earlier chapters, I discussed how hundreds of studies on primates conducted over the last half century have found in various ways that the combination of certain genes and small amounts of early life stress can lead to lifelong anxious and depressive behavior in humans and other animals. But recent studies on rhesus monkeys by Stephen Suomi, the chief of the Laboratory of Comparative Ethology at the NIH, have found that when anxious monkeys were taken in early life from their anxious mothers and given to nonanxious mothers to be raised, a fascinating thing happened: these monkeys grew up to display less anxiety than their genetic siblings—and they also, intriguingly, tended to become the alpha males of the troop. This suggests that some quotient of anxiety not only enhances your odds of living longer but also, under the right circumstances, can equip you to be a leader.
My anxiety can be intolerable. It often makes me miserable. But it is also, maybe, a gift—or at least the other side of a coin I ought to think twice about before trading in. Perhaps my anxiety is linked to whatever limited moral sense I can claim. What’s more, the same anxious imagination that sometimes drives me mad with worry also enables me to plan effectively for unforeseen circumstances or unintended consequences that other, less vigilant temperaments might not. The quick social judging that is allied to my performance anxiety is also useful in helping me to size up situations quickly and to manage people and defuse conflict.
My Age of Anxiety: Fear, Hope, Dread, and the Search for Peace of Mind Page 39