by Daniel Smith
I cleared my throat.
“We’ve been pretty worried about you,” he said. “All those calls. We know it’s been tough.”
It’s remarkable just how quickly mental weather can go extreme. We were only twenty words and one participant into the conversation and already I could feel the hysteria rising up in me like coffee in a percolator. I felt I couldn’t allow it to spill over. Not in front of my father, whom I wanted to see in me at least the semblance of masculine fortitude, and not in front of my mother—not again. Not now that I had packed up and said my good-byes. Not now that I had reached the age of legal maturity and therefore, I felt (being far stupider than I realized), of mental self-sufficiency. There seemed to be large matters of propriety and self-respect at stake, and so I lowered my head and focused my eyes on the small patch of scuffed brick at my feet; just a glance at the memorial or my parents’ worried faces, or even at the faces of normal human pedestrians, and I knew I’d be a goner. And I clenched—a Herculean, full-body-and-mind clenching. Never in my life have I concentrated so intently on making sure that every muscle, organ, membrane, and thought are held in static check. The only common analogy I can think of is the state of being at once exceedingly nauseated and dead-set on not vomiting. I found a quivering equilibrium.
Then my mother took over.
“I know how you’re feeling,” she said. “I’ve been where you are. I see it in my patients every day. You’re confused and you’re scared.” I braced myself. The bricks at my feet seemed to soften. “I can see the anxiety in your eyes. You’re staring at everything like it’s going to jump out and grab you around the neck. I know what it feels like to be vigilant like that. It’s horrible. It’s awful. You feel like you’re going crazy.” I heard a spate of giggles in the distance, from just around the spot where the crowd emerges from faux-Buchenwald into the open air. Things began to loosen further. “You feel like something terrible is going to happen at any moment. It’s awful. Awful.” Something, curiosity or fear, compelled me to glance up and I saw a group of teenage girls walking away from the monument licking lollipops. Lollipops! I quickly put my head back down. “But nothing bad is going to happen to you, Daniel. I promise you. Nothing bad is going to happen. You’re not dying. You’re not going crazy. It just feels like you’re going crazy. But that’s all this is. You have to see that. That’s all it is: a feeling. It isn’t real. It’s just a feeling.”
There was a slim part of me, an intellectual sliver located somewhere in my forebrain, that wanted to argue with my mother regarding the distinction between feelings and reality. Was there one? Really? It didn’t seem like it. But that part was quickly subsumed by the rising anxiety, which now reached the point at which tears were unavoidable. My mother saw them begin to fall.
“Oh, Daniel,” she said, stroking my back between my shoulder blades. “You’re not crazy. Honey, you’re going to be okay. You’re just anxious. You have severe anxiety . . . like me. It’s a mental disorder, that’s all. You just need some help to get you through it. Therapy. Some medication. You have a condition, a treatable condition.”
And with that—my first ever diagnosis—my anxiety at last breached the borders. Like me. On a concrete island two hundred miles from home I’d unwittingly attended my own coronation, and I saw at once that there was little hope of abdication. Darwin was right about panic: the hairs bristle, the breathing is hurried, the muscles fail, the mental faculties are much disturbed. Utter prostration soon followed.
9.
an actor prepares
My parents said I could come home with them if I wanted. It was the easiest thing there was. I would just need to pack my things and we’d head for the interstate. We could call the registrar’s office from the road. But I decided to stick it out, and from the way my parents nodded their heads I could tell they were pleased. What purpose would I serve at home? What good would it do me to putter aimlessly around the house? I would sleep for twelve hours a day and read for a few more. What would I do with the remaining nine?
But there was a catch. If I was going to stay at school, my mother insisted, I would have to seek professional help. “There are two-and-a-half months between now and winter break,” she said. “There’s no reason you should have to get through that time on your own. A trained therapist, someone to talk to and learn from, could be an enormous help. It’s the only way, sweetheart.”
And that is how, on the Tuesday after my panic attack, I found myself frozen in a paranoiac haze on the border between the road that encircled the campus and the asphalt footpath that led to the university’s behavioral-health center.
It was early in the morning. There was no one on the road behind me and no one on the path in front of me. All the blinds in the windows of the building that housed the center were shut against the morning sun. I was alone. Yet I felt as if I were about to waltz onto the stage at Carnegie Hall. Standing there with just a short distance to cover—a mere eighty feet lay between me and the center’s front door—I was thoroughly convinced that once I started walking a multitude of eyes from every direction would lock onto me, all of them hungry for the sight of a student actually freaked out enough to visit the campus shrink, like those eighteenth-century Londoners who’d head to the madhouse on an idle Sunday to ogle psychotics.
I was determined to avoid such a humiliation. There had been too many humiliations, too many compromises, already. The trouble was, my determination left me with only two options as to how to proceed. I could abort mission, continuing along the road until it looped back to my dorm, after which I would be duty-bound to return home; or I could labor against every impulse in my being to affect a demeanor contrary to my actual state, so that anyone who saw me make the trip from curb to clinic would be unable to imagine that I was doing so for therapy. In short, I could give up or I could try to fake it.
I decided on the second.
• • •
When I was eight years old, I auditioned for and won a part in a regional traveling production of the musical Oliver! I was one of Fagin’s kids, a coal-smudged thief in an oversized tweed cap. It wasn’t a speaking part, but it did include a featured moment. In Act I, right after singing an ode to the pleasures of pickpocketing, the boys have a laugh at Fagin’s expense. Fagin enters the room, the boys get scared, and they hush up one by one until there is a single, oblivious laugher remaining: me.
I prepared for that moment as if I were DeNiro preparing for Raging Bull. I studied the actors in my favorite TV shows to see how they laughed. I practiced each evening in the bathroom mirror, thinking comic thoughts, running the faucet at full volume so my brothers wouldn’t hear me. I tracked down every reference to orphans in the Encyclopædia Britannica, hoping to find clues as to how one would experience mirth. But no matter how hard I worked I could not get that laugh to sound natural. At one of our last performances, at an outdoor festival, my father discovered me behind the costume trailer only minutes before curtain, still testing out variations.
“Ha ha ha! Hee hee hee! Ho ho ho! Mwah ha ha! Heh heh heh! Tee hee hee! Hrump hrump hrump!”
“Just laugh like yourself,” my father said.
When the run ended, I quit the theater forever.
I mention this failure because the theatrical task I faced a decade later was exponentially more difficult than having to produce an authentic laugh. To make myself appear casual and unperturbed while in the throes of paranoia and terror seemed not only challenging but impossible.
The first obstacle, as I see it now, was physical. Professional actors are forever having to contend with the limitations of their bodies. Wallace Shawn, for example, is a gifted and experienced actor, but slight, gnomish, and reedy-voiced as he is he’ll never play a thug or soldier except for comic effect. Some things you just can’t change. For the anxiety sufferer trying to come off as normal, the limitations of the body are complicated by the fact that the body he has is no longer the one he’s always known. His body has already changed, and what
he inhabits is alien and uncomfortable. He isn’t trying to transform himself into something different; he’s trying to transform someone different back into himself.
On that October morning, paralyzed there on the cusp of therapy, anxiety had transformed my appearance as thoroughly as if I’d swallowed Jekyll’s potion. My back was knotted and hunched, my shoulders were up to my ears, my skin was pallid and clammy, my cheeks were gaunt, and my fingertips were torn and scabbed from my gnawing at them day and night. Years later, in a biography of William James, I would come across a self-portrait he’d drawn during his own youthful bout with anxiety:
I looked like a standing version of this. I would’ve preferred to have looked like this:
There is a good psychological reason why it is so difficult to change how you look once you are deep into anxiety. Before getting into that reason, however, it’s worth pausing to say more about those gnawed fingers, for the habit that got them into such bad shape is both one of the most familiar and most misunderstood aspects of anxiety. Nail-biting—that tell-tale sign of addled nerves—is more than just an unattractive tendency or cosmetic violation, as is commonly thought. It’s also a scourge.
An example: Right now, as I write, I am looking at the ring finger of my left hand. I write, when I am writing by hand, with my right hand, which means that when I am anxious I am free to chew on the nails of my left hand as I work. This doesn’t help the process of composition—it doesn’t improve thought—but it gives the illusion of helping composition, which is enough and maybe even the same thing, in the end. I have been chewing on this particular nail for three days, bit by tiny bit, snipping off just enough with each mouth-entry to satisfy my compulsion but not so much that I’ll put myself out of business altogether.
This morning, though, there was an accident. I got a satisfying tag of nail between my teeth and, distracted by an uncooperative sentence, I put too much oomph into the follow-through and tore off a strip of nail about a sixteenth of an inch in width. This exposed the soft, spongy flesh beneath, which ballooned out like the ice cream in an ice cream sandwich when it’s had too much time to melt and you hold it too tightly.
How to describe the pain that results when the nail bed comes into contact with air? What it feels like, until the nail grows back over the exposed area, is like a fusillade of microscopic knitting needles being fired by a battery of tiny howitzers poised at around the level of the first knuckle. And this pain, as the result of some neuroelectrical mechanism or other, reverberates inwardly even as it is being shot outwardly: The joints start to ache. There’s an inflammatory aspect to the experience. Then the heart gets involved. Informed of the insult, it sends some extra blood to the region, to facilitate healing. But it feels like what the heart has sent is itself, like it has assessed the situation and decided that the best thing for it to do is to pull up stakes and bivouac right there in the fingertip until things blow over. Which means a new, heightened, rhythmic type of pain, a Looney Tunes pulsation that unlike in cartoons doesn’t go away quickly because there the nail bed is, newbornishly exposed, which it will remain for a long time because human nails grow surprisingly slowly.
I’ve experienced some pain in my time: fractured digits, lacerations, dislocations, sprains, concussions, corneal abrasions, intestinal infections. Exposed nail bed pain is worse. It is worse partly because it’s self-inflicted and therefore shameful but also because, being self-inflicted, the mind can’t help but come up with rationalizations for the injury. Which would be useful, a sort of retrospective self-protection, if the mind in anxiety happened to be completely delusive. But because in anxiety the mind is only half-delusive, the non-delusive half immediately brands the rationalization (e.g., “Nail-biting is a valid form of grooming that’s as old as the hominids, and that’s what I was up to”) as a rationalization without having any impact whatsoever on the delusive, rationalization-forming half of the mind, and this intrapsychic conflict (bear with me here) registers as a totalizing sense of humiliating self-ridiculousness. And then this totalizing sense of humiliating self-ridiculousness increases the pain signal.
This is all very perverse and recursive and hard enough to process when there’s only one masticated finger. But it is the rare nail-biter who is so controlled. I started biting my nails after Esther, then stopped, then started again when I arrived at college. By the time I stood steeling myself to cross the no-man’s-land separating me from the clinic, I had ten fingers whose nails I had gnawed clean, plus various and assorted nibbles, tears, gouges, and chew marks farther south. My hands looked as if they had been manicured with an immersion blender. In my first weeks away I wore Band-Aids, but in time the damage grew so extensive that to cover all the wounds I would have had to wear multiple bandages on every finger, which would almost certainly have raised an administrative red flag. So I wandered from class to class with my hands thrust into the pockets of my jeans, where the jagged nail edges and skin flaps attracted lint and crumbs and other detritus, or else got caught on stray threads, exacerbating the bleeding and intensifying the pain.
• • •
I checked my watch. There were exactly four minutes until the start of my session. In this part of campus, there were a lot of trees and large boulders. It was possible that someone was watching and judging me even now. Scanning the grounds, I thought I detected movement down by the athletic center. I’d have to work quickly if I was going to fool anyone.
I began with my posture. Of all the corrupted aspects of my body, it seemed like the easiest one to correct: stop slouching. But to my surprise, I found that I could no more stand straight than I could sprout wings and fly to therapy. Curiously, this was not because my spine disobeyed the command to straighten; it was because my mind refused to issue the command in the first place. My brain—my perplexed, worn-out brain—didn’t want to budge. Wasn’t going into work this morning. Was calling in sick. Sorry, boss, you’re going to have to stay slumped today.
In the years since that moment, I’ve come to recognize this kind of mental intransigence as the second obstacle to acting calm when you are anxious. It is a problem that tends to progress the further into a spate of anxiety you get. The process is reminiscent of Stockholm syndrome: The longer the brain is exposed to anxiety’s relentless messages of hopelessness and despair, the more convinced it becomes that those messages convey the ineluctable truth. This isn’t surprising when you remember that the brain evolved to protect the organism against injury and death. The brain is good at pleasure; it likes orgasms, glucose, and companionship. But it is exceptional at fear. If the brain wasn’t a first-class fear-monger, if it wasn’t always ready and poised to pound on the alarm bells, then a threat to the organism might end the whole game before there was any chance to experience pleasure. In evolutionary terms, fear trumps all else.
Anxiety, though, is different from fear, and to understand why faking it can be so hard it’s important to know just how they’re different. Freud was of the opinion that in fear a person is responding to a specific and immediate threat to physical safety while in anxiety a person is responding to a threat that is objectless, directionless, and located somewhere far off in the future—ruination, for example, or humiliation, or decay. This was already the standard line in his day and it’s still the standard line, for good reason. The distinction highlights the untethered quality of anxiety—what a contemporary of Freud’s called the “meaningless frenzy” of the experience. A current expert, the psychologist David Barlow, defines fear as “a primitive alarm in response to present danger, characterized by strong arousal and action tendencies.” Anxiety is “a future-oriented emotion, characterized by perceptions of uncontrollability and unpredictability over potentially aversive events and a rapid shift in attention to the focus of potentially dangerous events or one’s own affective response to those events.” That last clause—“one’s own affective response to those events”—is just a fancy way of saying that anxious people pay a lot of attention to their own anxie
ty.
And yet to talk about anxiety as directionless and formless and fear as focused and specific only says how the two experiences are different, not how they’re related. It also suggests, in a backhanded way, that fear is normal, a hardwired Darwinian response, and that anxiety is abnormal, a sort of postindustrial, urban affliction. No experts say this outright, or even at all. Everyone acknowledges that anxiety is an ancient and ubiquitous emotion that only becomes abnormal when it is out of proportion to whatever threatening event might—possibly, maybe—happen. Normal anxiety is a state of arused preparedness. Abnormal anxiety is an overreaction.
For example, if you are camping out in an African animal preserve and you have trouble sleeping because you don’t want to be eaten alive, you’re normally anxious. If you’re drinking beer at a bar in Fort Lauderdale and you’re edgy because one day you might go off on a camping trip during which an animal will stroll into your tent and eat you alive, you need a prescription. Still, because the traditional line on fear and anxiety doesn’t link the two up very well, anxiety comes off with an unmistakably clinical reputation.
Which is why I’ve come to prefer a newer view of fear and anxiety. This comes from the eminent psychiatrist Aaron Beck. Beck agrees that fear is more focused and fundamental than anxiety, but he changes the equation by emphasizing the mental rather than the physical basis of fear. By doing this he manages to get fear and anxiety under the same roof, namely the skull, and to connect them logically. Fear, Beck writes,
is a primitive automatic neurophysiological state of alarm involving the cognitive appraisal of imminent threat or danger to the safety and security of an individual. Anxiety is a complex cognitive, affective, physiological and behavioral response system (i.e., threat mode) that is activated when anticipated events or circumstances are deemed to be highly aversive because they are perceived to be unpredictable, uncontrollable events that could potentially threaten the vital interests of an individual.