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

by Scott Stossel

  At The Atlantic, I am grateful to colleagues (and former colleagues) who endured my periodic absences and filled in for me while I worked on the book, among them Bob Cohn, James Fallows, Geoff Gagnon, James Gibney, Jeffrey Goldberg, Corby Kummer, Chris Orr, Don Peck, Ben Schwarz, Ellie Smith, and Yvonne Rolzhausen. (On the business side, Atlantic president Scott Havens, Atlantic Media president Justin Smith, and Atlantic Media chairman and owner David Bradley showed blessed forbearance in allowing me time to work on this book.) More than any other Atlantic colleagues, though, I owe Jennifer Barnett, Maria Streshinsky, and James Bennet, who were exceedingly generous in working around the problems my absences caused. I worry I’ve taken years off James’s life.

  Despite everything, I am grateful to Dr. L., Dr. M., Dr. Harvard, Dr. Stanford, and various other therapists and social workers and hypnotists and pharmacologists who are not named or got left on the cutting room floor. I am unreservedly and ongoingly grateful to Dr. W.: thank you for helping keep me afloat.

  I want to thank my family—especially my dad, my mom, my sister, and my grandfather. I love them all. None of them (with the qualified exception of my father) were happy I was writing this book—and they were all even unhappier to be included in it themselves. (I am especially grateful to my father for sharing his diary with me.) I have tried to be as accurate and objective as my memory and the limited documentary record permit. Some family members would dispute aspects of what I have written here. I worry that some in my family view my revelations about Chester Hanford as a desecration of his memory and a posthumous despoiling of his dignity. For what it’s worth, I respect him tremendously, and I hope that in my own anxious struggle I can live up to the standards of grace, decency, kindness, and perseverance he embodied. (I owe special thanks to my grandfather, who—though he made clear he didn’t want to know what was in his father’s psychiatric records—was willing to let me find out and helped me navigate probate court to secure them.)

  As ever, my deepest thanks go to my wife, Susanna. Early on, she logged many hours at the National Institutes of Health Library, tracking down scientific articles and books. She also went far beyond any reasonable expectation of spousal support in helping me fight through legal thickets and bureaucratic impediments to gain access to the mental health records of my great-grandfather. Most important, if you’ve read this book, you know that holding me together can sometimes be challenging, unrewarding work. That work falls most heavily on Susanna—and for that I owe her more than I can ever repay.

  Notes

  CHAPTER 1: THE NATURE OF ANXIETY

  1 accounting for 31 percent of the expenditures: Figure on anxiety and mental health care expenditures comes from “The Economic Burdens of Anxiety Disorders in the 1990s,” a comprehensive report published in The Journal of Clinical Psychiatry 60, no. 7 (July 1999).

  2 “lifetime incidence” of anxiety disorder: Ronald Kessler, an epidemiologist at Harvard, has spent decades studying this. See, for instance, his paper “Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication,” Archives of General Psychiatry 62, no. 6 (June 2005): 593–602.

  3 A study published: R. C. Kessler et al., “Prevalence and Effects of Mood Disorders on Work Performance in a Nationally Representative Sample of U.S. Workers,” The American Journal of Psychiatry 163 (2006): 1561–68. See also “Economic Burdens.”

  4 the median number of days: U.S. Bureau of Labor Statistics, “Table R67: Number and Percent Distribution of Nonfatal Occupational Injuries and Illnesses Involving Days Away from Work by Nature of Injury or Illness and Number of Days Away from Work, 2001.”

  5 Americans filled fifty-three million prescriptions: Drug Topics, March 2006.

  6 Xanax prescriptions jumped 9 percent nationally: “Taking the Worry Cure,” Newsweek, February 24, 2003. See also Restak, Poe’s Heart, 185.

  7 the economic crash caused prescriptions: Report from Wolters Kluwer Health, a medical information company, cited in Restak, Poe’s Heart, 185.

  8 A report published in 2009: Mental Health Foundation, In the Face of Fear, April 2009, 3–5.

  9 A recent paper: “Prevalence, Severity, and Unmet Need for Treatment of Mental Disorders in the World Health Organization World Mental Health Surveys,” The Journal of the American Medical Association 291 (June 2004): 2581–90.

  10 A comprehensive global review: “Prevalence and Incidence Studies of Anxiety Disorders: A Systematic Review of the Literature,” The Canadian Journal of Psychiatry 51 (2006): 100–13.

  11 other studies have reported similar findings: For instance, “Global Prevalence of Anxiety Disorders: A Systematic Review and Meta-regression,” Psychological Medicine 10 (July 2012): 1–14.

  12 Primary care physicians report: See, for instance, “Content of Family Practice: A Data Bank for Patient Care, Curriculum, and Research in Family Practice—526,196 Patient Problems,” The Journal of Family Practice 3 (1976): 25–68.

  13 One large-scale study from 1985: “The Hidden Mental Health Network: Treatment of Mental Illness by Non-psychiatric Physicians,” Archives of General Psychiatry 42 (1985): 89–94.

  14 one in three patients complained: “Panic Disorder: Epidemiology and Primary Care,” The Journal of Family Practice 23 (1986): 233–39.

  15 20 percent of primary care patients: “Quality of Care of Psychotropic Drug Use in Internal Medicine Group Practices,” Western Journal of Medicine 14 (1986): 710–14.

  16 “Woody Allen gene”: See, for instance, Peter D. Kramer, “Tapping the Mood Gene,” The New York Times, July 26, 2003. See also Restak, Poe’s Heart, 204–12.

  17 “The real excitement here”: Thomas Insel, “Heeding Anxiety’s Call” (lecture, May 19, 2005).

  18 “as vain as a child’s story”: Roccatagliata, History of Ancient Psychiatry, 38.

  19 “if one’s body and mind”: Maurice Charlton, “Psychiatry and Ancient Medicine,” in Historical Derivations of Modern Psychiatry, 16.

  20 “All that philosophers have written”: Charlton, “Psychiatry and Ancient Medicine,” 12.

  21 One study found that children: See, for instance, Rachel Yehuda et al., “Trans-generational Effects of Posttraumatic Stress Disorder in Babies of Mothers Exposed to the World Trade Center Attacks During Pregnancy,” The Journal of Clinical Endocrinology and Metabolism 90, no. 7 (July 2005): 4115 Rachel Yehuda et al., “Gene Expression Patterns Associated with Posttraumatic Stress Disorder Following Exposure to the World Trade Center Attacks,” Biological Psychiatry 66(7)(2009): 708–11.

  22 “Myself and fear were born twins”: Quoted in Hunt, Story of Psychology, 72.

  23 There’s also evidence that: See, for instance, “The Relationship Between Intelligence and Anxiety: An Association with Subcortical White Matter Metabolism,” Frontiers in Evolutionary Neuroscience 3, no. 8 (February 2012). (Also on high Jewish IQ: Steven Pinker, who in 2007 gave a lecture called “Jews, Genes, and Intelligence,” says “their average IQ has been measured at 108 to 115.” Richard Lynn, author of the 2004 article “The Intelligence of American Jews,” says Jewish intelligence is half a standard deviation higher than the European average. Henry Harpending, Jason Hardy, and Gregory Cochran, University of Utah authors of the 2005 research report “Natural History of Ashkenazi Intelligence,” state that their subjects “score .75 to 1.0 standard deviations above the general European average, corresponding to an IQ of 112–115.”)

  24 An influential study: “The Relation of Strength of Stimulus to Rapidity of Habit-Formation,” The Journal of Comparative Neurology and Psychology 18 (1908): 459–82.

  25 “We then face the prospect”: Los Angeles Examiner, November 4, 1957, quoted in Tone, Age of Anxiety, 87.

  26 “Van Gogh, Isaac Newton”: Los Angeles Examiner, March 23, 1958, quoted in Tone, Age of Anxiety, 87.

  27 “Without anxiety, little would be accomplished”: Barlow, Anxiety and Its Disorders, 9.

  28 “I awoke morning after morning”: James, Variet
ies of Religious Experience, 134.

  29 Petraeus … “rarely feels stress at all”: Steve Coll, “The General’s Dilemma,” The New Yorker, September 8, 2008.

  CHAPTER 2: WHAT DO WE TALK ABOUT WHEN WE TALK ABOUT ANXIETY?

  1 “usually linked with a strong”: Jaspers, General Psychopathology, 113–14.

  2 “a sense of foreboding”: Lifton, Protean Self, 101.

  3 “the internal precondition of sin”: Niebuhr, Nature and Destiny, vol. 1, 182.

  4 “the most pervasive psychological phenomenon”: Hoch and Zubin, Anxiety, v.

  5 “The mentalistic and multi-referenced term”: Theodore R. Sarbin, “Anxiety: Reification of a Metaphor,” Archives of General Psychiatry 10 (1964): 630–38.

  6 “to feelings”: Kagan, What Is Emotion?, 41.

  7 “as wine to vinegar”: See, for instance, “Three Essays on the Theory of Sexuality,” in Freud, Basic Writings.

  8 “with a manual stimulation”: Quoted in Roccatagliatia, History of Ancient Psychiatry, 204.

  9 “It is almost disgraceful”: Freud, Problem of Anxiety, 60.

  10 “When a mother is afraid”: Horney, Neurotic Personality, 41.

  11 Studies of the: DSM-II: See, for instance, R. Spitzer and J. Fleiss, “A Re-analysis of the Reliability of Psychiatric Diagnosis,” The British Journal of Psychiatry 125 (1974): 341–47; Stuart A. Kirk and Herb Kutchins, “The Myth of the Reliability of DSM,” Journal of Mind and Behavior 15, nos. 1–2 (1994): 71–86.

  12 “stress tradition”: For more on the stress tradition, see the section “Anxiety and the Stress Tradition” in Horwitz and Wakefield, All We Have to Fear, 200–4.

  13 “a sister, fidus Achates”: Burton, Anatomy, 261.

  14 “are affrighted still”: Ibid., 431.

  15 “Don’t allow the sum total”: Breggin, Medication Madness, 331.

  16 Moreover, the brain of a research subject: Kagan, What Is Emotion?, 83.

  17 humans whose amygdalae get damaged: See, for instance, “Fear and the Amygdala,” The Journal of Neuroscience 15, no. 9 (September 1995): 5879–91.

  18 “the final and most exciting contest”: Cannon, Bodily Changes, 74.

  19 “The progress from brute to man”: James, Principles of Psychology, 415.

  20 “One day”: Quoted in Fisher, House of Wits, 81.

  21 “Contrary to the view of some humanists”: LeDoux, Emotional Brain, 107.

  22 Even Aplysia californica: This comes from the research of Eric Kandel, which is described in Barber, Comfortably Numb, 191–96.

  23 “It is not obvious”: Kagan, What Is Emotion?, 17.

  24 “entering a seemingly involuntary state”: Barlow, Anxiety and Its Disorders, 35.

  25 “How many hippos worry”: Sapolsky, Zebras, 182.

  26 “A rat can’t worry”: Quoted in Stephen Hall, “Fear Itself,” The New York Times Magazine, February 28, 1999.

  27 “Theta activity is a rhythmic burst”: Gray and McNaughton, Neuropsychology of Anxiety, 12.

  28 “This remark of Plato”: Maurice Charlton, “Psychiatry and Ancient Medicine,” in Galdston, Historic Derivations, 15.

  29 Meditation led to decreased density: G. Desbordes et al., “Effects of Mindful-Attention and Compassion Meditation Training on Amygdala Response to Emotional Stimuli in an Ordinary, Non-meditative State,” Frontiers of Human Neuroscience 6 (2012): 292.

  30 Other studies have found that Buddhist monks: See, for instance, Richard J. Davidson and Antoine Lutz, “Buddha’s Brain: Neuroplasticity and Meditation,” IEEE Signal Processing Magazine 25, no. 1 (January 2008): 174–76.

  31 suppress their startle response: See, for instance, R. W. Levenson, P. Ekman, and M. Ricard, “Meditation and the Startle Response: A Case Study,” Emotion 12, no. 3 (June 2012): 650–58; for additional context, see Tom Bartlett, “The Monk and the Gunshot,” The Chronicle of Higher Education, August 21, 2012.

  32 even old-fashioned talk therapy: Richard A. Friedman, “Like Drugs, Talk Therapy Can Change Brain Chemistry,” The New York Times, August 27, 2002.

  33 “My theory”: William James first articulated this in “What Is an Emotion?,” an article he published in Mind, a philosophy journal, in 1884.

  34 When researchers at Columbia: S. Schachter and J. E. Singer, “Cognitive, Social, and Physiological Determinants of Emotional State,” Psychological Review 69, no. 5 (1962): 379–99. Joseph LeDoux has a good description of this experi-ment, and of the history of the James-Lange theory, in Emotional Brain, 46–49.

  35 “fear of death, conscience, guilt”: Tillich, “Existential Philosophy,” Journal of the History of Ideas 5, no. 1 (1944): 44–70. (This later appeared in Tillich’s 1959 book Theology of Culture.)

  36 the moment an anxious patient: See, for instance, Gabbard, “A Neurobiologically Informed Perspective on Psychotherapy,” The British Journal of Psychiatry 177 (2000): 11; A. Öhman and J. J. F. Soares, “Unconscious Anxiety: Phobic Responses to Masked Stimuli,” Journal of Abnormal Psychology (1994); John T. Cacioppo et al., “The Psychophysiology of Emotion,” Handbook of Emotions 2 (2000): 173–91.

  37 Richard Burton could not bear: Shawn, Wish, 10.

  38 how to eliminate fear responses in cats: Joseph Wolpe, Psychotherapy by Reciprocal Inhibition (Stanford, Calif.: Stanford University Press, 1958), 53–62.

  39 “chimney sweeping”: Breger, Dream, 29.

  CHAPTER 3: A RUMBLING IN THE BELLY

  1 “scare the hell out of the patient”: David Barlow “Providing Best Treatments for Patients with Panic Disorder,” Anxiety and Depression Association of American Annual Conference, Miami, March 24, 2006.

  2 phobia cure rate of up to 85 percent: Lauren Slater, “The Cruelest Cure,” The New York Times, November 2, 2003.

  3 Barlow himself has a phobia: “A Phobia Fix,” The Boston Globe, November 26, 2006.

  4 “It’s from 1979”: J. K. Ritow, “Brief Treatment of a Vomiting Phobia,” American Journal of Clinical Hypnosis 21, no. 4 (1979): 293–96.

  5 “a phobia and a beef-steak”: Northfield, Conquest of Nerves, 37.

  6 as many as 12 percent: Harvard Medical School, Sensitive Gut, 71.

  7 First identified in 1830: Ibid., 72.

  8 In one well-known set of experiments: William E. Whitehead et al., “Tolerance for Rectosigmoid Distention in Irritable Bowel Syndrome,” Gastroenterology 98, no. 5 (1990): 1187; William E. Whitehead, Bernard T. Engel, and Marvin M. Schuster, “Irritable Bowel Syndrome,” Digestive Diseases and Sciences 25, no. 6 (1980): 404–13.

  9 an article in the medical journal Gut: Ingvard Wilhelmsen. “Brain-Gut Axis as an Example of the Bio-psycho-social Model,” Gut 47, supp. 4 (2000): 5–7.

  10 “nervous in origin”: Walter Cannon, “The Influence of Emotional States on the Functions of the Alimentary Canal,” The American Journal of the Medical Sciences 137, no. 4 (April 1909): 480–86.

  11 between 42 and 61 percent: Andrew Fullwood and Douglas A. Drossman, “The Relationship of Psychiatric Illness with Gastrointestinal Disease,” Annual Review of Medicine 46, no. 1 (1995): 483–96.

  12 40 percent overlap between patients: Robert G. Maunder, “Panic Disorder Associated with Gastrointestinal Disease: Review and Hypotheses,” Journal of Psychosomatic Research 44, no. 1 (1998): 91.

  13 “Fear brings about diarrhea”: Quoted in Roccatagliata, History of Ancient Psychiatry, 106.

  14 “People attacked by fear”: Quoted in Sarason and Spielberger, Stress and Anxiety, vol. 2, 12.

  15 “90 percent redness”: Wolf and Wolff, Human Gastric Function, 112.

  16 One of the more alarming: Richard W. Seim, C. Richard Spates, and Amy E. Naugle, “Treatment of Spasmodic Vomiting and Lower Gastrointestinal Distress Related to Travel Anxiety,” The Cognitive Behaviour Therapist 4, no. 1 (2011): 30–37.

  17 weeping at a sad play: Alvarez, Nervousness, 123.

  18 The nervousness and hypersensitivity: Ibid., 266.

  19 “The stomach specialist has to be”: Ibid., 11.


  20 “day and night for a week”: Ibid., 22.

  21 “a tense, high-pressure type of sales manager”: Ibid., 17.

  22 “the cruelest prank of nature”: Ibid.

  23 A study published in: Angela L. Davidson, Christopher Boyle, and Fraser Lauchlan, “Scared to Lose Control? General and Health Locus of Control in Females with a Phobia of Vomiting,” Journal of Clinical Psychology 64, no. 1 (2008): 30–39.

  24 As the British physician and philosopher: Tallis, Kingdom of Infinite Space, 193.

  25 “Age 56–57”: Quoted in Desmond and Moore, Darwin, 531.

  26 “Diary of Health”: Cited at length in Colp, To Be an Invalid, 43–53.

  27 “knocked up”: Desmond and Moore, Darwin, 530.

  28 “We liked Dr. Chapman”: Quoted in Colp, To Be an Invalid, 84.

  29 “What the devil is this”: Hooker, Life and Letters of Joseph Dalton Hooker, vol. 2, 72.

  30 “Darwin’s Illness Revealed”: Anthony K. Campbell and Stephanie B. Matthews, “Darwin’s Illness Revealed,” Postgraduate Medical Journal 81, no. 954 (2005): 248–51.

  31 “bad headache”: Bowlby, Charles Darwin, 229.

  32 “Charles Darwin and Panic Disorder”: Thomas J. Barloon and Russell Noyes Jr., “Charles Darwin and Panic Disorder,” The Journal of the American Medical Association 277, no. 2 (1997): 138–41.

  33 “neurotic hands”: Edward J. Kempf, “Charles Darwin—the Affective Sources of His Inspiration and Anxiety Neurosis,” The Psychoanalytic Review 5 (1918): 151–92.

  34 one pseudoscholarly paper: Jerry Bergman, “Was Charles Darwin Psychotic? A Study of His Mental Health” (Institute of Creation Research, 2010).

  35 “the most miserable which I ever spent”: Darwin, Autobiography, 28. 92 “I was out of spirits”: Ibid., 28.