by Daniel Smith
Here’s his plain-English version: “Fear is the appraisal of danger; anxiety is the unpleasant feeling state evoked when fear is stimulated.”
This version of things goes far in explaining why I had such a hard time straightening out my back when I was standing at the start of the footpath to the clinic. In Beck’s account, there are two main stages in the gestation of clinical anxiety. In the first stage, fear is stimulated—a threat is noticed—and an “unpleasant feeling state” is evoked. This is a hopeful time, relatively, because while the unpleasant feeling state is really and truly unpleasant, it’s also new and unusual. It’s not foreign: Everyone has experienced anxiety in situations where anxiety is warranted—while waiting for medical test results, for example. But the first time that you experience anxiety that has no obvious connection to a logical threat, in a situation in which the vast bulk of humanity would fail to respond with anxiety, you know it. It feels wrong. It feels off. It feels crazy. This is good. It means you still have a chance. This is the optimal time to hie thee to a therapist, the woods, an ashram. This is the time, before the great vindictive hand of Jehovah slams shut the gate, to dive back into Eden and cling tightly to a well-rooted tree. Because the gate will close. That’s how the brain operates; it is frighteningly quick to form habits. And Beck’s unpleasant feeling state is a self-perpetuating little bastard. Fear—of something, anything—calls it up and, jittery as it is genetically determined to be, it looks for other things to be scared of. It responds to fear by looking for fear, and the world being the world, it finds it. In this way, the merry-go-round of anxiety is fired up. The loop begins: fear to anxiety to fear to anxiety to fear to anxiety. This is the second stage and it is really hard to get out of.
• • •
It isn’t impossible, however. There are ways to break the cycle. Most of these ways, of course, are laborious. They mean sitting down for months or years on end, fighting to alter the mental habits of a lifetime. In short, they mean therapy of one sort or another. But what if your mental habits are precisely what are keeping you from therapy? What if, like me, you are so anxious that you can’t even move, let alone think rationally? How do you combat paralysis?
The strange answer I discovered that morning was . . . you just do. In dire situations, those in which obligation or desperation seem to leave you with no choice, you can still exercise your will. Like the Lorax at the end of the Dr. Seuss book, gripping the seat of his own pants and lofting himself into the sky, you retain within you the ability to wrench yourself out of your anxious state and into action, if only for a moment.
I almost gave up. I almost turned around and headed back for the dorm and Long Island. But as I was standing there, going to town on my nails with an especially compulsive fervor, I heard the sound of a car coming down the road, heading in my direction, and, motivated by the same fear of exposure that had been keeping me motionless, I forced myself to take a first step. Doing this meant engaging in an almost athletic way of thinking, in which I had to envision my conscious will as a sort of slothful, stupefied figure within my head. I envisioned this will of mine and I pretended it was my job to rouse him, to shake him alert so he could do the job I needed him to do. It was as though my will were one of those world-weary ex-cops in action movies whom the mayor turns to when the city is being tormented by unprecedentedly resourceful terrorists and what it needs desperately is a savior, any savior, even one with a bum knee, a five-day stubble, and no respect for authority.
Things didn’t go well at first. As I took one step, then another, then another, calm was decidedly not the attitude projected. The attitude projected was more like acute lower-GI distress. Every muscle in my body felt leaden and rigor mortic.
Then, somehow, I found a groove. Which is to say, I found a pattern of movement I could ease into and sustain. My arms started to swing more lightly, my hips bobbed and swayed, my head straightened out on my neck. It was my first taste of the knowledge that this was possible, that the mechanics of my existence allowed for internal and external life to diverge so radically, and that I was able to manage it says something, I think, about the strangeness of the conscious will, which, short of finely calibrated pharmaceutical interventions, can only be activated by itself—like God summoning himself into existence. Not that my mind, as I made my way down the path, was on metaphysics. One of the things anxiety educates you in is how deeply physical thought can be, how concrete. In anxiety, there is no time to luxuriate in abstractions. It’s just you and your mind, which has fists and is using them. It may be dualistic and logically untenable to posit the situation as You v. Head; it may not make sense philosophically. But in the throes of anxiety? In the cognitive shit? There’s really no other way to think about what’s going on.
• • •
The therapist was the only person I have ever seen outside of silent movies who stroked his beard to illustrate that he was thinking. He was slim and short and thirty at the oldest. His office, which I gathered he shared with several other fledgling shrinks, resembled the office of a teaching assistant in one of the university’s less respected academic departments. It wasn’t much larger than a tool shed, and not much neater. Tall piles of manila folders lay on a series of cheap aluminum shelves. Case notes, I assumed—the life stories and weekly unravelings of the furtively afflicted. There was barely enough space in the room to fit the chairs on which we sat, facing each other. When the therapist hitched up his pants, our knees kissed.
“So what brings you here today?” he asked.
My heart fell. “What brings you here today?” It was such a hackneyed question, a line from a bad script. Couldn’t he have done better than that? It didn’t seem to bode well. Since he was only my second therapist, I didn’t yet know that all therapeutic openings are hackneyed. There is no original way to ask a person why he is feeling unwell enough to seek help. Therapeutic openings always make me feel sorry for the therapist, who has the difficult job of having both to elicit the patient’s history and difficulties and to establish an attitude of authoritative concern. “How can I help you?” “Tell me a bit about yourself.” “What’s bothering you?” Compared to the alternatives, “What brings you here today?” is actually pretty good: open-ended, present-tense, oriented toward the petitioner rather than the petition.
“I suffer from anxiety,” I said, and then a stiff jolt of awareness struck me somewhere in my abdomen, for I’d never said it like that before. I’d never used the word in that kind of sentence. I’d used it, usually in adjectival form: “I’m feeling anxious.” I knew, because I had looked it up, that Xanax was an “anxiolytic,” and that the root of “anxiolytic” was “anxiety” (Latin anxietas: fretfulness). I knew that all the words that applied here and there to my experience—sadness, depression, nervousness, despair, dissociation, obsession, distraction, self-awareness, hysteria, angst, dejection—were satellites orbiting around the main word, the main event: anxiety. And yet there was something more than accuracy at play here. The setting made things more complicated than that. Saying “I suffer from anxiety” to a therapist changed the word from a descriptor to an act of acquiescence—a bowing to the authority of pathology.
Then I was surprised again by what the therapist did next. The poor man must have been as nervous as I was, because after nodding sympathetically for a few seconds he reached to a shelf behind him, pulled down a thick psychology textbook, and proceeded to flip through it. When he had found the page he was looking for he gave his beard a few languid strokes and read.
“Anxiety,” he said. “Anxiety is a relatively permanent state of worry and nervousness occurring in a variety of mental disorders, usually accompanied by compulsive behavior or attacks of panic.” He raised his eyes. “Is this what you’ve been feeling?” he asked. “Would you say this describes your experience accurately?”
I nodded. “Yes, I think so. I think that about describes it.”
He turned the page. His beard received further ministration.
“There’s a table in here,” he said. “A list of criteria that will help us determine whether what you’re feeling is . . . well, whether it’s a problem or not. I’m going to read these aloud to you. Is that all right?”
“Yeah. OK.”
“Here we go then,” he said. “Number one. Would you say that you’ve been anxious more often than not for the past six months?”
“Uh, no. Not really. It’s pretty new. Well this time it is. I’ve had it before. I’ve gone through it before. But this time it’s only been for about a month, since school started. But it’s been bad, really bad. Like, constant.”
“So that’s a ‘no’ then.” He twisted over to his desk and scribbled a note. “That’s good. That’s a good sign. Let’s go on to number two. Would you say you have difficulty controlling your worry?”
“Oh, yeah. Definitely. Yes.”
He scribbled again. “Three. Please answer yes or no to the following symptoms. Do you feel restless, keyed up, or on edge?”
“Yes.”
“Are you easily fatigued?”
“Yes.”
“Do you have difficulty concentrating?”
“Yes.”
“Are you irritable?”
“Yes.”
“Do you feel any muscle tension?”
“Yes.”
“And finally, do you have sleep disturbance?”
“Sleep disturbance?”
“Trouble getting to sleep, trouble staying asleep, unsatisfying sleep.”
“Yes.”
“Right, six out of six.”
“Is that bad?”
He affected a neutral tone. “There’s no good or bad here. We’re just trying to determine what’s troubling you. Now, then, question number four. . . . Well, four I can’t really ask you. Four is a little technical. Let’s move on to five. Would you say that your anxiety causes you impairment in social, occupational, or other important areas of functioning?”
I felt like I might cry if I spoke, so I nodded.
“Is that a yes?”
I nodded more vigorously. He made an empathy face. “I know this is hard. There’s not much more.”
I nodded.
“Six. Is your anxiety due to the direct physiological effects of medication, substance abuse, or a general medical condition such as hyperthyroidism, and is it exclusive of a mood disorder, a psychotic disorder, or . . . well, wait. I’m seeing now that this one might be hard for you to answer, too. So let’s just—let’s just skip it.”
I started to cough, to beat back the tears.
“Maybe we should just”—he was thumbing through the book now as I coughed louder—“maybe the thing to do would be”—he flipped to the index, scanning it with one hand while with the other he played with his beard—“maybe we should just talk a little then.”
“But do you think—”
“See where it takes us. Just discuss what you’ve been feeling.”
“Do you think—”
“Hash it out.”
“Do you think there’s, like, something wrong with me?”
He leaned way back in his chair. Our knees touched again.
“Don’t quote me on this,” he said. “But I’d say there’s definitely something off kilter.”
10.
people of the book
I made my way back along the footpath and onto the campus proper. The session made the college seem even more foreign and forbidding than before. Walking into the shadow of the science complex, I recalled a statistic our guide had conveyed, inexplicably, on our campus tour. Each academic year at the university, she announced to the assembled families, more mice were decapitated for experiments than students graduated. I scrambled back into daylight.
Then, at the top of a hill leading to the Castle, an imposing medieval replica complete with turrets, corbels, buttresses, and battlements, I caught a sight through scattered oaks of the entrance to the library, and my mood improved. I hadn’t been inside the library since my truncated attempt at therapeutic breathing; it had taken on, like a growing number of settings in my life, the queasy aura of my discomfort.
This now struck me as intensely stupid. The library: of course! The library was the solution to my predicament, the only conceivable place on campus I’d be able to find the solitude I needed and the wisdom I wanted. I had no intention of going back to the clinic. (I’d lie to my parents from then on.) What was the point? I could do better than some newly minted shrink just scanning the shelves, picking out clues and consolations when and from where it felt right to me. And how it felt right. With a therapist you have to sit and be prodded into self-examination no matter how anxious you are. With books you can shut the process down at any moment with the flip of a cover. If a book wasn’t working for you, if you found it too offensive or contrary or pretentious or slight, you could simply choose another. Being in the library was like being in the perfect sanatorium. How could I not have realized this?
Well, I realized it now, and I let that realization lead me through the doors and past the thrumming, crowded computer stations. For the next four months, until winter break, I barely left the library’s crypt-like lower levels.
• • •
Some months ago, my brother Scott e-mailed me a document along with a note that said, “Just thought you might like to see how it’s shaking out.” The document was titled thebookofscott.doc, and it consisted of about forty quotations organized into five “chapters”: Discipline, Awareness, Fear, Creativity, and General Tonic. Scott had been accumulating the quotations for several months, ever since, in the same two-week period, his wife gave birth and he started a new job and he found that, once again, hypochondriasis was making life difficult to lead. His goal was to produce a compact volume of wisdom—a kind of commonplace book—that he could use to pull himself together whenever he felt his nerves growing frayed.
One motivation for the project was envy. My brothers and I grew up in a Jewish but largely secular home. Each of us had a bar mitzvah, but we managed to emerge from childhood with little understanding of, and littler faith in, religious texts. Scott is convinced that our lack of religion has handicapped us psychologically. “It’s not really fair, when you think about it,” he told me when he began the project. “We’re surrounded by people who came into this world with these portable little bundles of certainty, these neat foundational texts. They don’t have to go rooting around for comforting words. They were handed to them at birth—pre-edited, pre-legitimized, pre-authorized. There are almost seven billion people on the planet and ninety percent have scriptures. And what do we have? What did we get? Nothing. A handful of movies and a few of Dad’s jokes. We’re at sea. We’ve always been at sea.”
It remains to be seen whether The Book of Scott will close the gap between my brother and the world’s devout. Yet looking over its contents recently (Milton: “He who reigns within himself and rules his passions, desires, and fears, is more than a king.” Santayana: “Let a man once overcome his selfish terror at his own finitude, and his finitude is, in one sense, overcome.” Flaubert: “Shut up and get on with it.”) I couldn’t help but regret that I didn’t have something like it to guide me during those long months I spent in the bowels of the college library. The qualities embodied by Scott’s selections—simplicity, mindfulness, pragmatism, stoicism—are exactly those qualities an anxious person needs to foster in himself if he is going to change in any real and lasting way. They are the qualities common to every therapeutic literature that has ever been useful to anyone, and at the age of eighteen I didn’t have the first clue they were what I should be searching out.
There are many sections in a library where an anxious young man might find solace and self-understanding: poetry, philosophy, theology, psychology, art. Being fond of stories, I gravitated toward the fiction stacks. I staked a claim to a carrel beside the Vs and Ws in twentieth-century American literature, in a dim corner of the first basement level, and between dutiful sessions attending to c
lass assignments, I began to range at random through the offerings.
I found myself reading anything whose opening lines, scanned standing up in the narrow alleys between the shelves, felt capable of coaxing my anxiety down from its stubborn heights. Nabokov famously said that one should gauge literature with “the top of the tingling spine.” I gauged it with the icicle in my chest. If, reading the first sentences of a novel, my icicle thawed, I would carry the book with me back to the carrel and jump in. If my icicle began to swell and stick in my sternum, I would slam the book shut and replace it on the shelf. In this way, the masterworks of modern American literature began to shake out according to a sort of ad hoc neurotic analysis. James, Faulkner, O’Connor, Cheever, DeLillo, Gaddis, and Pynchon were among those deemed, for whatever unconscious reasons, too anxiety-provoking to absorb. Those who made the cut included Hemingway, Bellow, Updike, Doctorow, and Styron. But the author whom my icicle urged me to read more avidly than any other that year, the author who, once I discovered him, seemed to articulate my condition with such uncanny precision that his novels came to be not just a comfort but an explanation—a diagnostic source—was Philip Roth. When I found Roth, I felt I had found my anxiety’s Rosetta Stone.
The affinity was immediate. The first Roth book I pulled from the shelf was The Ghost Writer, his eighth. It was like looking into a mirror. Here, making his inaugural appearance, was Nathan Zuckerman—Roth’s “alter-consciousness,” as he has fastidiously called his creation—and he was just like me: a bookish, sensitive, libidinous young man trying to make his way following a cloistered childhood in a loving Jewish home. No, change that: trying to make his way in spite of a cloistered childhood in a loving Jewish home. For that was the conflict, the stark, startling, surprisingly resonant conflict at the core of the novel. Zuckerman, just a few years removed from being “an orthodox college atheist and highbrow-in-training,” has written a story based on an embarrassing episode in his family’s past and finds himself, suddenly and for the first time, the object of his parents’ disapproval. Ambitious, passionate, idealistic to a fault, he has set out to exert his will on the world and discovered that he is more bound than he had ever imagined to the concern, authority, and love—above all the love, to which he has an “addiction”—of his formidable, doting family.