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Surviving Anxiety
I've tried therapy, drugs, and booze. Heres how I came to terms with the nation's most common mental illness.
SCOTT STOSSELDEC 22 2013, 9:25 PM ET
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!amie "hung
Ive #inally settled on a pre$tal% regimen that enables me to avoid the wee%s o# anticipatory misery that the approach o# a public$
spea%ing engagement would otherwise produce.
&ets say youre sitting in an audience and Im at the lectern. Heres what Ive li%ely done to prepare. our hours or so ago, I too% my
#irst hal# milligram o# (ana). *Ive learned that i# I wait too long to ta%e it, my #ight$or$#light response %ic%s so #ar into overdrive that
medication is not enough to yan% it bac%.+ hen, about an hour ago, I too% my second hal# milligram o# (ana) and perhaps- milligrams o# Inderal. *I need the whole milligram o# (ana) plus the Inderal, which is a blood$pressure medication, or beta$
bloc%er, that dampens the response o# the sympathetic nervous system, to %eep my physiological responses to the an)ious stimulus
o# standing in #ront o# you/the sweating, trembling, nausea, burping, stomach cramps, and constriction in my throat and chest/
#rom overwhelming me.+ I li%ely washed those pills down with a shot o# scotch or, more li%ely, vod%a, the odor o# which is less
detectable on my breath. Even two (ana) and an Inderal are not enough to calm my racing thoughts and to %eep my chest and
throat #rom constricting to the point where I cannot spea%0 I need the alcohol to slow things down and to subdue the residual
physiological eruptions that the drugs are inade1uate to contain. In #act, I probably dran% my second shot/yes, even though I might
be spea%ing to you at, say, 2 in the morning/between 34 and 5 minutes ago, assuming the pre$tal% proceedings allowed me a
moment to snea% away #or a 1ua##.
I# the usual pattern has held, as I stand up here tal%ing to you now, Ive got some (ana) in one poc%et *in case I #elt the need to pop
another one be#ore being introduced+ and a minibar$size bottle or two o# vod%a in the other. I have been %nown to ta%e a discreet
last$second swig while wal%ing onstage/because even as Im still e)periencing the an)iety that ma%es me want to drin% more, my
inhibition has been lowered, and my 6udgment impaired, by the li1uor and benzodiazepines Ive already consumed. I# Ive managed
to hit the sweet spot/that per#ect combination o# timing and dosage whereby the cognitive and psychomotor sedating e##ect o# the
drugs and alcohol balances out the physiological hyperarousal o# the an)iety/then Im probably doing o%ay up here7 nervous but not
miserable0 a little #uzzy but still able to spea% clearly0 the an)iogenic e##ects o# the situation *me, spea%ing in #ront o# people+
counteracted by the an)iolytic e##ects o# what Ive consumed. 8ut i# Ive overshot on the medication/too much (ana) or li1uor/I
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may seem to be loopy or slurring or otherwise impaired. 9nd i# I didnt sel#$medicate enough: ;ell, then, either Im sweating
pro#usely, with my voice 1uavering wea%ly and my attention #olding in upon itsel#, or, more li%ely, I ran o##stage be#ore I got this #ar.
I mean that literally7 Ive #rozen, morti#yingly, onstage at public lectures and presentations be#ore, and on several occasions I have
been compelled to bolt #rom the stage.
I had worn grooves in the carpet o# my bedroom with my relentless pacing, trying to will my parents to
come home. ?uring #irst grade, I spent nearly every a#ternoon #or months in the school nurses o##ice, sic% with psychosomatic
headaches, begging to go home0 by third grade, stomachaches had replaced the headaches, but my daily trudge to the in#irmary
remained the same. ?uring high school, I would purposely lose tennis and s1uash matches to escape the agony o# an)iety thatcompetitive situations would provo%e in me. =n the one/the only/date I had in high school, when the young lady leaned in #or a
%iss during a romantic moment *we were outside, gazing at constellations through her telescope+, I was overcome by an)iety and had
to pull away #or #ear that I would vomit. My embarrassment was such that I stopped returning her phone calls.
In short, I have, since the age o# about -, been a twitchy bundle o# phobias, #ears, and neuroses. 9nd I have, since the age o# 3, when
I was #irst ta%en to a mental hospital #or evaluation and then re#erred to a psychiatrist #or treatment, tried in various ways to
overcome my an)iety.
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Heres what Ive tried7 individual psychotherapy *three decades o# it+, #amily therapy, group therapy, cognitive$behavioral therapy,
rational emotive behavior therapy, acceptance and commitment therapy, hypnosis, meditation, role$playing, interoceptive e)posure
therapy, in vivo e)posure therapy, sel#$help wor%boo%s, massage therapy, prayer, acupuncture, yoga, Stoic philosophy, and
audiotapes I ordered o## a late$night @ in#omercial.
9nd medication. &ots o# medication. horazine. Imipramine. ?esipramine. "hlorpheniramine. Aardil. 8uSpar. rozac. Bolo#t. a)il.
;ellbutrin. E##e)or. "ele)a. &e)apro. "ymbalta. &uvo). razodone. &evo)yl. Inderal. ran)ene. Sera). "entra). St. !ohns wort.
Bolpidem. @alium. &ibrium. 9tivan. (ana). Clonopin.
9lso7 beer, wine, gin, bourbon, vod%a, and scotch.
Heres whats wor%ed7 nothing.
9ctually, thats not entirely true. Some drugs have helped a little, #or #inite periods o# time. horazine *an antipsychotic that used to
be re#erred to as a Dma6or tran1uilizer+ and imipramine *a tricyclic antidepressant+ combined to help %eep me out o# the psychiatric
hospital in the early 32Fs, when I was in middle school and ravaged by an)iety. ?esipramine, another tricyclic, got me through my
early -s. a)il *a selective serotonin reupta%e inhibitor, or SSGI+ gave me about si) months o# signi#icantly reduced an)iety in my
late -s be#ore the #ear bro%e through again. 9 double scotch plus a (ana) and a ?ramamine can sometimes, when administered
be#ore ta%eo##, ma%e #lying tolerable. 9nd two double scotches, when administered in 1uic% enough succession, can obscure
e)istential dread, ma%ing it seem #uzzier and #urther away.
8ut none o# these treatments has #undamentally reduced the underlying an)iety that seems hardwired into my body and woven into
my soul and that at times ma%es my li#e a misery.
My assortment o# neuroses may be idiosyncratic, but my general condition is hardly uni1ue. 9n)iety and its associated disorders
represent the most common #orm o# o##icially classi#ied mental illness in the nited States today, more common even than
depression and other mood disorders. 9ccording to the Aational Institute o# Mental Health, some million 9merican adults, about
one in si), are su##ering #rom some %ind o# an)iety disorder at any given time0 based on the most recent data #rom the ?epartment o#
Health and Human Services, their treatment accounts #or more than a 1uarter o# all spending on mental$health care. Gecent
epidemiological data suggest that one in #our o# us can e)pect to be stric%en by debilitating an)iety at some point in our li#etime. 9nd
it is debilitating7 studies have compared the psychic and physical impairment tied to living with an an)iety disorder with the
impairment tied to living with diabetes/both conditions are usually manageable, sometimes #atal, and always a pain to deal with. In
-3-, 9mericans #illed nearly 4 million prescriptions #or 6ust one antian)iety drug7 alprazolam, the generic name #or (ana).
Ive abandoned dates; walked out of exams; and had breakdowns during job interviews, on flights, and simply walking down thestreet.
9nd an)iety, o# course, e)tends #ar beyond the population o# the o##icially mentally ill. In a much$cited 32>J study, primary$care
physicians reported that an)iety was one o# the most #re1uent complaints driving patients to their o##ices/more #re1uent than the
common cold. 9lmost everyone alive has at some point e)perienced the torments o# an)iety/or o# #ear or o# stress or o# worry, which
are distinct but related phenomena. *eople who are unable to e)perience an)iety are, according to some theorists, more deeply
pathological/and more dangerous to society/than those who e)perience it acutely or irrationally0 theyre psychopaths.+
My li#e has, than%#ully, lac%ed great tragedy or melodrama. I havent served any 6ail time. I havent been to rehab. I havent assaulted
anyone or attempted suicide. I havent wo%en up na%ed in the middle o# a #ield, so6ourned in a crac% house, or been #ired #rom a 6ob
#or erratic behavior. 9s psychopathologies go, mine has been/so #ar, most o# the time, to outward appearances/1uiet. Gobert
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?owney !r. will not be starring in the movie o# my li#e. I am, as they say in the clinical literature, Dhigh #unctioning #or someone
with an an)iety disorder or other mental illness0 Im usually 1uite good at hiding it. his is a signature characteristic o# the phobic
personality7 Dthe need and the ability, as described in the sel#$help boo% Your Phobia, Dto present a relatively placid, untroubled
appearance to others, while su##ering e)treme distress on the inside. o some people, I may seem calm. 8ut i# you could peer
beneath the sur#ace, you would see that Im li%e a duc%/paddling, paddling, paddling.
Stigma still attaches to mental illness. 9n)iety is seen as wea%ness. In presenting my an)iety to the world by writing publicly about
it, Ive been told, I will be, in e##ect, Dcoming out. he implication is that this will be liberating. ;ell see about that. 8ut my hope is
that readers who share this a##liction, to whatever e)tent, will #ind some value in this account/not a cure #or their an)iety, but
perhaps some sense o# the redemptive value o# an o#ten wretched condition, as well as evidence that they can cope and even thrive in
spite o# it. Most o# all, I hope they/and by Dthey I mean Dmany o# you/will #ind some solace in learning that they are not alone.
Stupe#ied by horazine and e)hausted by an a#ternoon o# an)iety$induced gastric distress, the author, age 3-, be#ore a classmate's
bar mitzvah in 32F- *"ourtesy o# the Stossel #amily+
I struggle with emetophobia, a pathological #ear o# vomiting, but its been a while since I last vomited. More than a while, actually7 as
I type this, its been, to be precise, 54 years, two months, #our days, -5 hours, and 5 minutes. Meaning that more than F5 percent o#
my days on Earth have transpired in the time since I last threw up, during the early evening o# March >, 32>>, when I was > years
old. I didnt vomit in the 32Fs. I didnt vomit in the 322s. I havent vomited in the new millennium. 9nd needless to say, I hope to
ma%e it through the balance o# my li#e without having that strea% disrupted. *Aaturally, I was reluctant even to type this paragraph,
and particularly that last sentence, #or #ear o# 6in)ing mysel# or inviting cosmic rebu%e, and I am %noc%ing on wood and o##ering up
prayers to various gods and ates as I write this.+
;hat this means is that I have spent, by rough calculation, at least J percent o# my wa%ing li#e thin%ing about and worrying about
something that I have spent zero percent o# the past three$plus decades doing. his is irrational.
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9nd yet, an astonishing portion o# my li#e is built around trying to evade vomiting and preparing #or the eventuality that I might
throw up. Some o# my behavior is standard germophobic stu##7 avoiding hospitals and public restrooms, giving wide berth to sic%
people, obsessively washing my hands, paying care#ul attention to the provenance o# everything I eat.
8ut other behavior is more e)treme, given the statistical unli%elihood o# my vomiting at any given moment. I stash motion$sic%ness
bags, purloined #rom airplanes, all over my home and o##ice and car in case Im suddenly overta%en by the need to vomit. I carry
epto$8ismol and ?ramamine and other antiemetic medications with me at all times. &i%e a general monitoring the enemys
advance, I %eep a detailed mental map o# recorded incidences o# norovirus *the most common strain o# stomach virus+ and other
#orms o# gastroenteritis, using the Internet to trac% outbrea%s in the nited States and around the world. Such is the nature o# my
obsession that I can tell you at any given moment e)actly which nursing homes in Aew Bealand, cruise ships in the Mediterranean,
and elementary schools in @irginia are contending with outbrea%s. =nce, when I was lamenting to my #ather that there is no central
clearinghouse #or in#ormation about norovirus outbrea%s the way there is #or in#luenza, my wi#e inter6ected. D
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Dhis is 6ust a single case, I said. DIts #rom 32>2.
Dhere have been lots o# others, she said, and reminded me again o# her colleagues patient.
DI cant do it.
D
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8y now I was starting to #eel a little nauseated. Suddenly I was struc% by heaving and I turned to the toilet. I retched twice/but
nothing was coming up. I %nelt on the #loor and waited, still hoping the event would come 1uic%ly and then be over. he monitor on
my #inger #elt li%e an encumbrance, so I too% it o##.
9#ter a time, I heaved again, my diaphragm convulsing. Aurse G. e)plained that dry heaving precedes the main event. I was now
desperate #or this to be over.
he nausea began coming in intense waves, crashing over me and then receding. I %ept #eeling li%e I was going to vomit, but then I
would heave noisily and nothing would come up. Several times I could actually #eel my stomach convulse. 8ut I would heave and L
nothing would happen.
My sense o# time at this point gets blurry. ?uring each bout o# retching, I would begin perspiring pro#usely, and once the nausea
passed, I would be dripping with sweat. I #elt #aint, and I worried that I would pass out and vomit and aspirate and die. ;hen I
mentioned #eeling light$headed, Aurse G. said that my color loo%ed good. 8ut I thought she and ?r. M. seemed slightly alarmed.
his increased my an)iety/because i# theywere worried, then I should really be scared, I thought. *=n the other hand, at some level
I wantedto pass out, even i# that meant dying.+
9#ter about minutes and several more bouts o# retching, ?r. M. and Aurse G. suggested I ta%e more ipecac. 8ut I #eared a second
dose would sub6ect me to worse nausea #or a longer period o# time. I worried that I might 6ust %eep dry heaving #or hours or days. 9t
some point, I switched #rom hoping that I would vomit 1uic%ly and be done with the ordeal to thin%ing that maybe I could #ight the
ipecac and simply wait #or the nausea to wear o##. I was e)hausted, horribly nauseated, and utterly miserable. In between bouts o#
retching, I lay on the bathroom tiles, sha%ing.
9 long period passed. Aurse G. and ?r. M. %ept trying to convince me to ta%e more ipecac, but by now I 6ust wanted to avoid
vomiting. I hadnt retched #or a while, so I was surprised to be stric%en by another bout o# violent heaving. I could #eel my stomach
turning over, and I thought #or sure that this time something would happen. It didnt. I cho%ed down some secondary waves, and
then the nausea eased signi#icantly. his was the point when I began to #eel hope#ul that I would manage to escape the ordeal
without throwing up.
Aurse G. seemed angry. DMan, you have more control than anyone Ive ever seen, she said. *9t one point, she as%ed peevishly
whether I was resisting because I wasnt prepared to terminate therapy yet. ?r. M. inter6ected that this was clearly not the case/Id
ta%en the ipecac, #or Kods sa%e.+ Eventually/several hours had now elapsed since Id ingested the ipecac/Aurse G. le#t, saying she
had never seen someone ta%e ipecac and not vomit. Ive since read that up to 34 percent o# people/a disproportionate number o#
them surely emetophobes/dont vomit #rom a single dose o# ipecac.N 9#ter some more time, and some more encouragement #rom
?r. M. to try to Dcomplete the e)posure, we decided to Dend the attempt. I still #elt nauseated, but less so than be#ore. ;e tal%ed
brie#ly in her o##ice, and then I le#t.
?riving home, I became e)tremely an)ious that I would vomit and crash. I waited at red lights in terror.
;hen I got home, I crawled into bed and slept #or several hours. I #elt better when I wo%e up0 the nausea was gone. 8ut that night I
had recurring nightmares o# retching in the bathroom in the basement o# the center.
he ne)t morning I managed to get to wor% #or a meeting/but then panic surged and I had to go home. or the ne)t several days, I
was too an)ious to leave the house.
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?r. M. called the day a#ter the ordeal to ma%e sure I was o%ay. She clearly #elt bad about having sub6ected me to such a horrible
e)perience. hough I was traumatized, her sense o# guilt was so palpable that I #elt sympathetic toward her. 9t the end o# the
account I composed at her re1uest, which was accurate as #ar as it went, I mas%ed the emotional reality o# what I thought *which was
that the e)posure had been an ab6ect disaster and that Aurse G. was a #atuous bitch+ with an antiseptic clinical tone. DKiven my
history, I was brave to ta%e the ipecac, I wrote.
I wish that I had vomited 1uic%ly. 8ut the whole e)perience was traumatic, and my general an)iety levels/and my phobia o#
vomiting/are more intense than they were be#ore the e)posure. I also, however, recognize that, based on this e)perience in resisting
the e##ects o# the ipecac, my power to prevent mysel# #rom vomiting is 1uite strong.
Stronger, it seems, than ?r. M.s. She told me shed had to cancel all her a#ternoon appointments on the day o# the e)posure/
watching me gag and #ight with the ipecac had evidently made her so nauseated that she spent the a#ternoon at home, throwing up. I
con#ess I too% some perverse pleasure #rom the irony here/the ipecacI too% made someone elsevomit/but mainly I #elt
traumatized. It seems Im not very good at getting over my phobias but 1uite good at ma%ing my therapists sic%.
I continued seeing ?r. M. #or a #ew more months/we Dprocessed the botched e)posure and then, both o# us wanting to #orget the
whole thing, turned #rom emetophobia to various other phobias and neuroses/but the sessions now had an elegiac, desultory #eel.
;e both %new it was over.
he author with his grand#ather and great$grand#ather *at le#t, with cane+, who endured multiple hospitalizations and rounds o#
electroshoc% therapy #or an)iety between the 32s and 32Js. *"ourtesy o# the Stossel #amily+
Is pathological an)iety a medical illness, as Hippocrates and 9ristotle and many modern psychopharmacologists would have it: =r is
it a philosophical problem, as lato and Spinoza and the cognitive$behavioral therapists would have it: Is it a psychological problem,
a product o# childhood trauma and se)ual inhibition, as reud and his acolytes once had it: =r is it a spiritual condition, as SOren
Cier%egaard and his e)istentialist descendants claimed: =r, #inally, is it/as ;. H. 9uden and ?avid Giesman and Erich romm and
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9lbert "amus and scores o# modern commentators have declared/a cultural condition, a #unction o# the times we live in and the
structure o# our society:
he truth is that an)iety is at once a #unction o# biology and philosophy, body and mind, instinct and reason, personality and culture.
Even as an)iety is e)perienced at a spiritual and psychological level, it is scienti#ically measurable at the molecular level and the
physiological level. It is produced by nature and it is produced by nurture. Its a psychological phenomenon and a sociological
phenomenon. In computer terms, its both a hardware problem *Im wired badly+ and a so#tware problem *I run #aulty logic
programs that ma%e me thin% an)ious thoughts+. he origins o# a temperament are many$#aceted0 emotional dispositions that seem
to have a simple, single source/a bad gene, say, or a childhood trauma/may not. 9#ter all, whos to say that Spinozas vaunted
e1uanimity, though ostensibly a result o# his philosophy o# applying logical reasoning to irrational #ear, wasnt in #act a product o# his
biology: Mightnt a genetically programmed low level o# autonomic arousal have produced his serene philosophy, rather than the
other way around:
I dont have to loo% #ar to #ind evidence o# an)iety as a #amily trait. My great$grand#ather "hester Han#ord, #or many years the dean
o# Harvard "ollege, was in the late 32s admitted to Mc&ean Hospital, the #amous mental institution in 8elmont, Massachusetts,
su##ering #rom acute an)iety. he last 5 years o# his li#e were o#ten agonizing. hough medication and electroshoc% treatments
would occasionally bring about remissions in his su##ering, such respites were temporary, and in his dar%est moments, in the 32Js,
he was reduced to moaning in a #etal ball in his bedroom. erhaps wearied by the responsibility o# caring #or him, his wi#e, my great$
grandmother, a #ormidable and brilliant woman, died #rom an overdose o# scotch and sleeping pills in 32J2, a #ew months be#ore I
was born.
My mother, "hesters granddaughter, is, li%e me, an inveterate worrier, and, though she en6oyed a productive career as an attorney,
she su##ers #rom some o# the same phobias and neuroses that I do. She assiduously avoids heights *glass elevators, chairli#ts+, and
tends to avoid public spea%ing *when she has to tal% publicly, she ta%es beta$bloc%ers in advance+ and ris% ta%ing o# most %inds. &i%e
me, she is mortally terri#ied o# vomiting *and has not done so since 32>+. 9s a young woman, she su##ered #rom panic attac%s. 9t her
most an)ious *or so my #ather, her e)$husband, says+, her #ears verged on paranoia7 6ust a#ter I was born, while su##ering #rom
postpartum depression, she became convinced that a serial %iller in a yellow @ol%swagen was watching our house. *oday, my
mother and #ather, now divorced 34 years, disagree about the severity o# the paranoia7 my mother says it was negligible/and that,
moreover, there really was a serial %iller a#oot at the time, a #act that research con#irms.+ My only sibling, a younger sister who is a
success#ul cartoonist and editor, struggles with an)iety that is di##erent #rom mine but nonetheless intense. She, too, has ta%en
"ele)a/and also rozac and ;ellbutrin and Clonopin and Aardil and Aeurontin and 8uSpar. Aone o# them wor%ed #or her, and
today she may be one o# the #ew adult members o# my mothers side o# the #amily not currently ta%ing a psychiatric medication.
=n the evidence o# 6ust my mothers side o# the #amily *and there is a separate complement o# psychopathology coming down to me
on the side o# my #ather, a respected research physician who dran% himsel# unconscious many nights throughout much o# my later
childhood+, it is not outlandish to conclude that I possess what Sigmund reud called Dthe hereditary taint, a genetic predisposition
to an)iety and depression.
8ut these #acts, by themselves, are not dispositive. In the 32-s, my great$grandparents had a young child who died o# an in#ection.
his was devastating to them. erhaps this trauma, combined with the later trauma o# having many o# his students die in ;orld
;ar II, crac%ed something in my great$grand#athers psyche. erhaps my mother, in turn, was made an)ious by the #ussy
ministrations o# her worrywart mother0 the psychological term #or this is modeling. 9nd perhaps I, observing my mothers phobias,
adopted them as my own.
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=r maybe the generally unsettled nature o# my childhood psychological environment/my mothers constant an)ious buzzing0 my
#athers alcoholic absence0 their sometimes unhappy marriage, which would end in divorce/produced in me a comparably unsettled
sensibility. 8oth my mother and #ather were well intentioned and loving, but between them, they combined overprotection and
anger in a way that may have been particularly to)ic #or a child with an innately nervous temperament. =n many occasions, my
screaming bouts o# nighttime panic would awa%en the whole #amily, and my #ather would lie patiently with me, trying to calm me
down enough to sleep. 8ut sometimes, e)hausted and #rustrated, he would lash out at me physically. My mother dressed me until I
was 2 or 3 years old0 a#ter that, she pic%ed out my clothes #or me every night until I was about 34. She ran my baths until I was in
high school. 9ny time my sister and I were home while my parents were at wor%, we had the company o# a babysitter. 8y the time I
was a young teenager, this was getting a bit weird/as I realized the day I discovered, to our mutual discom#ort, that the babysitter
was my age *35+. My mother did all o# this out o# genuine love and an)ious concern. 9nd I welcomed the e)cess o# solicitude7 it %ept
me swaddled in a com#orting dependency. 8ut our relationship helped deprive me o# autonomy and a sense o# sel#$e##icacy.
$edi%ation has more reliably soothed my anxiety than other forms of therapy have. Yet the %ase for medi%ation is not at all %lear"
%ut.
Still, in most respects my parents maintained a sa#e, loving, and stable suburban home0 many people grow up in circumstances #ar
more traumatic than mine and dont develop clinical an)iety. ltimately, its impossible to disentangle nature and nurture/my
an)iety is surely the result o# both, and o# the interaction between the two. or instance, its possible that my mothers an)iety while
pregnant with me/having endured two miscarriages #ollowed by di##iculty getting pregnant again, she says her already high level o#
worry was in#lamed by the #ear that she wouldnt carry me to term/produced such hormonal Sturm und ?rang in the womb that I
was doomed to be born nervous. Gesearch suggests that mothers who su##er stress while pregnant are more li%ely to produce an)ious
children. homas Hobbes, the political philosopher, was born prematurely when his mother, terri#ied by a rumor that the Spanish
armada was advancing toward English shores, went into labor in 9pril 34FF. DMysel# and #ear were born twins, Hobbes wrote, and
he attributed his own an)ious temperament to the ambient turmoil o# his gestation. Maybe Hobbess view that a power#ul state
needs to protect citizens #rom the violence and torment they naturally in#lict on one another *li#e, he #amously said, is nasty, brutish,
and short+ had its origins in utero, as his mothers stress hormones washed through him.
=r do the roots o# my an)iety lie even deeper and e)tend more broadly than the things Ive e)perienced and the genes Ive inherited
/that is, in history and in culture: My #athers parents were !ews who emigrated #rom ;eimar Kermany. My #athers mother
became a nastily anti$Semitic !ew/she renounced her !ewishness out o# #ear that she would someday be persecuted #or it. My sister
and I were raised in the Episcopal "hurch, our !ewish bac%ground hidden #rom us until I was in high school. My #ather, #or his part,
has had a li#elong #ascination with ;orld ;ar II, and speci#ically with the Aazis0 he watched the 32>5P> television series &he
'orld at 'ar again and again. In my memory, that program, with its stentorian music accompanying the Aazi advance on aris, is
the running soundtrac% to my early childhood. !ews, o# course, have millennia o# e)perience in having reason to be scared/which
perhaps e)plains why some studies have suggested that !ewish men are more li%ely to su##er #rom neuroses than are men in other
groups.
My mothers cultural heritage, on the other hand, is heavily ;9S0 she is a proud $ayflowerdescendant who until recently
subscribed to the notion that there is no emotion and no #amily issue that should not be suppressed.
hus, me7 a mi)ture o# !ewish and ;9S pathology/a neurotic and histrionic !ew suppressed inside a neurotic and repressed
;9S. Ao wonder Im an)ious7 Im li%e ;oody 9llen trapped inside !ohn "alvin.
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9n)ious on
vacation7 the author, age 3, in 8ermuda *"ourtesy o# the Stossel #amily+
Everyone %nows that an)iety can cause gastrointestinal distress. *My #riend 9nne says that the most e##ective weight$loss program
she ever tried was the Stress#ul$?ivorce ?iet.+ 8ut medical researchers have charted the connections in precise and systematic detail7
as ones mental state changes, #or instance, so does blood #low to and #rom the stomach. he gastrointestinal system is a concrete
and direct register o# ones psychology. In their 325 landmar% o# psychosomatic research,(uman )astri% *un%tion, the physicians
Stewart ;ol# and Harold ;ol## concluded that there was a strong inverse correlation between what they called Demotional security
and stomach discom#ort.
hats certainly true in my case. 8eing an)ious ma%es my stomach hurt and my bowels loosen. My stomach hurting and my bowels
loosening ma%es me morean)ious, which ma%es my stomach hurt more and my bowels even looser, and so nearly every trip o# any
signi#icant distance #rom home ends up the same way7 with me scurrying #rantically #rom restroom to restroom on a %ind o# grand
tour o# the local latrines. or instance, I dont have terribly vivid recollections o# the @atican or the "olosseum or the Italian rail
system. I do, however, have detailed memories o# the public restrooms in the @atican and at the "olosseum and in various Italian
train stations in the winter o# --. =ne day, I visited the revi ountain/or, rather, my wi#e and her #amily visited the revi
ountain. I visited the restroom o# a nearby gelateria, where a series o# impatient Italians banged on the door while I bivouac%ed
there. he ne)t day, when the #amily drove to ompeii, I gave up and stayed in bed, a reassuringly short distance #rom the bathroom.
;hen your stomach governs your e)istence, its hard not to be preoccupied with it. 9 #ew searing e)periences/soiling yoursel# on an
airplane, say, or on a date *and yes, I have done both+/will #ocus you passionately on your gastrointestinal tract.
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that Hyannis ort, Massachusetts, where the Cennedys have their vacation homes, would be crawling with Secret Service agents.
;ith some time to %ill be#ore dinner, I decided to wal% around town to ta%e in the scene.
8ad idea. 9s is so o#ten the case #or people with unruly, nervous bellies, it was at precisely the moment I passed beyond Easily$
9ccessible$8athroom Gange that my plumbing came unglued. ;hile sprinting bac% to the house where I was staying, I was several
times convinced I would not ma%e it and/teeth gritted, sweating voluminously/was reduced to evaluating various bushes and
storage sheds along the way #or their potential as ersatz outhouses. Imagining what might ensue i# a Secret Service agent were to
happen upon me crouched in the shrubbery lent a %ind o# panic%ed, otherworldly strength to my e##orts at sel#$possession.
9s I approached the entrance, I was simultaneously reviewing the #loor plan in my head *'hi%h of the many bathrooms in the
mansion is %losest to the front door++ and praying that I wouldnt be #atally waylaid by a stray Cennedy or celebrity *as I recall,
9rnold Schwarzenegger, &iza Minnelli, and the secretary o# the Aavy, among others, were visiting that wee%end+.
ortunately, I made it into the house unaccosted. hen a 1uic% calculation7 an I make it all the way upstairs and down the hall to
my suite in time+ -r should I du%k into the bathroom in the front hall+Hearing #ootsteps above and #earing a protracted encounter,
I opted #or the latter and slipped into the bathroom, which was separated #rom the #ront hall by an anteroom and two separate doors.
I scampered through the anteroom and #lung mysel# onto the toilet.
My relie# was e)travagant and almost metaphysical.
8ut then I #lushed and L something happened. My #eet were getting wet. I loo%ed down and saw to my horror that water was #lowing
out #rom the base o# the toilet. Something seemed to have e)ploded. he #loor/along with my shoes and pants/was covered in
sewage. he water level was rising.
"ould the #looding be stopped: urning around, I removed the porcelain top o# the toilet tan%, scattering the #lowers and potpourri
that sat atop it, and #rantically began #iddling with its innards. I tried things blindly, raising this and lowering that, 6iggling this and
wiggling that, #ishing around in the water #or something that might stem the swelling tide.
Somehow, whether o# its own accord or as a result o# my haphazard #iddling, the #looding slowed and then stopped. I surveyed the
scene. My clothes were drenched and soiled. So was the bathroom rug. ;ithout thin%ing, I slipped o## my pants and bo)er shorts,
wrapped them in the waterlogged rug, and 6ammed the whole mess into the wastebas%et, which I stashed in the cupboard under the
sin%.(ave to deal with this later, I thought to mysel#.
It was at this unpropitious moment that the dinner bell rang, signaling that it was time to muster #or coc%tails in the living room.
;hich was right across the hall #rom the bathroom.
;here I was standing an%le$deep in sewage.
I pulled some towels o## the wall and dropped them on the ground to start sopping up some o# the toilet water. I got down on my
hands and %nees and, unraveling the whole roll o# toilet paper, began dabbing #renziedly at the water around me. It was li%e trying to
dry a la%e with a %itchen sponge.
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;hat I was #eeling at that point was not, strictly spea%ing, an)iety0 rather, it was a resigned sense that the 6ig was up, that my
humiliation would be complete and total. Id soiled mysel#, destroyed the estates septic system, and might soon be standing hal#
na%ed be#ore Kod %nows how many members o# the political and Hollywood elite.
In the distance, voices were moving closer. It occurred to me that I had two choices. I could hun%er down in the bathroom, hiding
and waiting out the coc%tail party and dinner/at the ris% o# having to #end o## anyone who might start %noc%ing on the door/and
use the time to try to clean up the wrec%age be#ore slipping up to my bedroom a#ter everyone had gone to bed. =r I could try to ma%e
a brea% #or it.
I too% all the soiled towels and toilet paper and shoved them into the cupboard, then set about preparing my escape. I retrieved the
least soiled towel *which was nonetheless dirty and sodden+ and wrapped it gingerly around my waist. I crept to the door and
listened #or voices and #ootsteps, trying to gauge distance and speed o# approach. Cnowing I had scarcely any time be#ore everyone
converged on the center o# the house, I slipped out o# the bathroom and through the anteroom, sprint$wal%ed across the hallway,
and darted up the stairs. I hit the landing, made a hairpin turn, and headed up the ne)t #light to the second #loor/where I nearly ran
headlong into !ohn . Cennedy !r. and another man.
DHi, Scott, Cennedy said. *Id 6ust met him #or the #irst time the day be#ore. DIm !ohn Cennedy, he had said when he e)tended his
hand in introduction.I know, I had thought as I e)tended mine, thin%ing it #unny that he had to pretend courteously that people
might not %now his name, despite the ubi1uity o# his #ace on the cover o# chec%out$counter magazines.+
Dh, hi, I said, rac%ing my brain #or a plausible e)planation #or why I might be running through the house at coc%tail hour with no
pants on, drenched in sweat, swaddled in a soiled and ree%ing towel. 8ut he and his #riend appeared utterly un#azed/as though hal#$
na%ed houseguests covered in their own e)crement were common here/and wal%ed past me down the stairs.
I scrambled down the hallway to my room, where I showered vigorously, changed, and tried to compose mysel# as best I could/
which was not easy because I was still sweating terribly, right through my blazer, the result o# an)iety, e)ertion, and summer
humidity.
(i, /%ott,0 1ennedy said. (e appeared unfa2ed3as though half"naked houseguests %overed in their own ex%rement were %ommonhere.
I# someone had snapped a photo o# the scene at coc%tails that evening, heres what it would show7 various celebrities and politicians
and priests all glowing with grace and easy bonhomie as they mingle e##ortlessly on the veranda overloo%ing the 9tlantic/while, 6ust
o## to the side, a sweaty young writer stands aw%wardly gulping gin and tonics and thin%ing about how #ar he is #rom #itting in with
this illustrious crowd and about how not only is he not rich or #amous or accomplished or particularly good$loo%ing, but he cannot
even control his own bowels and there#ore is better suited #or the company o# animals or in#ants than o# adults, let alone adults as
luminous and signi#icant as these.
he sweaty young writer is also worrying about what will happen when someone tries to use the hallway bathroom.
&ate that night, a#ter everyone had gone o## to bed, I snea%ed bac% down to the bathroom with a trash bag and paper towels and
cleaning detergent Id pil#ered #rom the pantry. I couldnt tell whether anyone had been there since I le#t, but I tried not to worry
about that and concentrated on stu##ing the soiled rug and towels and clothes and toilet paper Id stashed under the sin% into the
trash bag. hen I used the paper towels to scrub the #loor, and I put those into the trash bag as well.
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=utside the %itchen, between the main house and an outbuilding, was a ?umpster. My plan was to dispose o# everything there.
Aaturally, I was terri#ied o# getting caught. ;hat, e)actly, would a houseguest be doing disposing o# a large trash bag outside in the
middle o# the night: *I worried that there might still be Secret Service a#oot, who might shoot me be#ore allowing me to plant what
loo%ed li%e a bomb or a body in the ?umpster.+ 8ut what choice did I have: I slun% through the house and out to the ?umpster,
where I deposited the trash bag. hen I went bac% upstairs to bed.
Ao one ever said anything to me about the hallway bathroom or about the missing rug and towels. 8ut #or the rest o# the wee%end,
and on my subse1uent visits there, I was convinced that various household$sta## members were glaring at me and whispering.
Dhats him, I imagined they were saying in disgust. Dhe one who bro%e the toilet and ruined our towels. he one who cant control
his own bodily #unctions.
=n 9pril 35, -, at - ocloc% in the a#ternoon, I, then 5 years old and wor%ing as a senior editor at &he tlanti% and dreading the
publication o# my Sargent Shriver biography, presented mysel# at the nationally renowned "enter #or 9n)iety and Gelated ?isorders
at 8oston niversity. 9#ter meeting #or several hours with a psychologist and two graduate students and #illing out dozens o# pages
o# 1uestionnaires, I was given a principal diagnosis o# Dpanic disorder with agoraphobia and additional diagnoses o# Dspeci#ic
phobia and Dsocial phobia. he clinicians also noted in their report that my 1uestionnaire answers indicated Dmild levels o#
depression, Dstrong levels o# an)iety, and Dstrong levels o# worry.
;hy so many di##erent diagnoses: 9nd why were they di##erent #rom the diagnoses o# my youth *Dphobic neurosis, Doveran)ious
reaction disorder o# childhood+: Had the nature o# my an)iety changed so much: How can we ma%e scienti#ic or therapeutic
progress i# we cant agree on what an)iety is:
Even Sigmund reud, the inventor, more or less, o# the modern idea o# neurosis/a man #or whom an)iety was a %ey, i# not the%ey,
#oundational concept o# his theory o# psychopathology/contradicted himsel# over the course o# his career. Early on, he said that
an)iety arose #rom une)pressed se)ual impulses *an)iety is to repressed libido, he wrote, Das vinegar is to wine+. &ater in his career,
he argued that an)iety primarily arose #rom unconscious psychic con#licts. &ate in his li#e, in &he Problem of nxiety, reud wrote7
DIt is almost disgrace#ul that a#ter so much labor we should still #ind di##iculty in conceiving o# the most #undamental matters.
oday, the 9merican sychiatric 9ssociations4iagnosti% and /tatisti%al $anual*now in its 6ust$published #i#th edition,4/$"5+
de#ines hundreds o# mental disorders, classi#ies them by type, and lists, in levels o# detail that can seem both absurdly precise and
completely random, the symptoms a patient must display *how many, how o#ten, and with what severity+ to receive any given
psychiatric diagnosis. 9ll o# which lends the appearance o# scienti#ic validity to the diagnosing o# an an)iety disorder. 8ut the reality
is that there is a large 1uotient o# sub6ectivity here *both on the part o# patients, in describing their symptoms, and o# clinicians, in
interpreting them+. Studies in the 324s #ound that when two psychiatrists evaluated the same patient, they gave the same 4/$
diagnosis only about percent o# the time. Gates o# consistency have improved since then, but the diagnosis o# many mental
disorders remains, despite pretensions to the contrary, more art than science.
In the spring o# -, such was my terror over the looming boo% tour that I sought help #rom multiple sources. I #irst went to aprominent Harvard psychopharmacologist. D
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was, #eeling that this resistance was somehow noble or moral, that reliance on medication evinced wea%ness o# character, that my
an)iety was an integral and worthwhile component o# who I am, and that there was redemption in su##ering/until, inevitably, my
an)iety would become so acute that I would be willing to try anything, including the new medication. So, as usual, I capitulated, and
as the boo% tour drew closer, I began a course o# benzodiazepines *(ana) during the day, Clonopin at night+ and increased my
dosage o# "ele)a, an antidepressant I was already ta%ing.
8ut even drugged to the gills, I remained #illed with dread about the boo% tour, so I went also to the 8oston niversity center, and
was ultimately re#erred to a young but highly regarded Stan#ord$trained psychologist who specialized in cognitive$behavioral
therapy. Dirst thing weve got to do, she said in one o# my early sessions with her, Dis to get you o## these drugs. 9 #ew sessions
later, she o##ered to ta%e my (ana) #rom me and loc% it in a drawer in her des%. She opened the drawer to show me the bottles
deposited there by some o# her other patients, holding one up and sha%ing it #or e##ect. he drugs, she said, were a crutch that
prevented me #rom truly e)periencing and thereby con#ronting my an)iety0 i# I didnt e)pose mysel# to the raw e)perience o# an)iety,
I would never learn that I could cope with it on my own.
She had a point, I %new. 8ut with the boo% tour approaching, my #ear was that I might not, in #act, be able to cope with it.
I went bac% to the Harvard psychopharmacologist *lets call him ?r. Harvard+ and described the course o# action the Stan#ord
psychologist *lets call her ?r. Stan#ord+ had proposed. D
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Even as a high$school student, the author still struggled with severe separation an)iety, ma%ing it hard #or him to spend e)tended
time away #rom home and #amily. *"ourtesy o# the Stossel #amily+
My own e)perience, o# course, involves ample e)posure to both drugs and other therapies, o#ten in concert. Starting when I was 33, I
saw the same psychiatrist once or twice a wee% #or -4 years. ?r. &. was the psychiatrist who, when I was ta%en to Mc&ean Hospital,
administered my #irst Gorschach test. ;hen I started therapy with him, he was approaching 4, tall and lan%y, balding a little, with a
beard in the classic reudian style. =ver the years, the beard came and went, and he lost more o# his hair, which turned #rom brown
to salt$and$pepper to white. rained at Harvard in the 324s and early 32Js, ?r. &. came o# pro#essional age in the late stages o# the
psychoanalytic heyday, when reudianism still dominated. ;hen I #irst encountered him, he was a believer both in medication and
in such reudian concepts as neurosis and repression, the =edipus comple) and trans#erence. =ur #irst sessions, in the early 32Fs,
were #illed with things li%e Gorschach tests and #ree association and discussions o# early memories. =ur last sessions, in the mid$
-s, were #ocused on role$playing and Denergy wor%0 he also suggested during those latter years that I sign up #or a special %ind
o# yoga program, later alleged to be a brainwashing cult by some #ormer members, though their claims were never proved.
Heres some o# what we did in our sessions together over a 1uarter century7 loo%ed at picture boo%s *32F3+0 played bac%gammon
*32F-PF4+0 played darts *32F4PFF+0 e)perimented sporadically with various cutting$edge psychotherapeutic methods o# an
increasingly Aew 9ge comple)ion, such as hypnotism, eye$movement desensitization and reprocessing, energy$systems therapy, and
internal$#amily$systems therapy *32FFP-+. ?uring this period I also moved, in tandem with prevailing pharmacological trends,
#rom one class o# drugs to another, in o#ten overlapping succession7 #rom antipsychotics to benzodiazepines to tricyclic
antidepressants to M9=I antidepressants to SSGI antidepressants bac% to benzodiazepines again. I was the bene#iciary, or possibly
the victim, o# seemingly every passing #ad in psychotherapy and psychopharmacology.
Medication has more reliably soothed my an)iety than various other #orms o# therapy have. *;ithout horazine and imipramine and
@alium, I dont %now that I could have gotten through seventh grade.+
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that, in the case o# many drugs, can be #ar worse than the side e##ects. ;hile lots o# people will testi#y that drugs have helped them,
lots o# other people will testi#y *and o#ten do, in court #ilings and be#ore "ongress+ that medication has ruined their lives. hough
plenty o# studies, and many individual e)periences, suggest that drugs can be highly e##ective in treating an)iety, the bene#its are at
the very least not clear$cut.
Sigmund reud relied heavily on drugs to manage his an)iety. Si) o# his earliest scienti#ic papers described the bene#its o# cocaine,
which he used regularly #or at least a decade, beginning in the 3FFs. =nly a#ter he prescribed the stimulant to a close #riend who
became #atally addicted did reuds enthusiasm wane. Much o# the history o# modern psychopharmacology has the same ad hoc
1uality as reuds e)perimentation with cocaine. Every one o# the most commercially signi#icant classes o# antian)iety and
antidepressant drugs o# the past J years was discovered by accident or was originally developed #or something completely
unrelated to an)iety or depression7 to treat tuberculosis, surgical shoc%, allergies0 to use as an insecticide, a penicillin preservative,
an industrial dye, a disin#ectant, roc%et #uel.
rozac and other, similar selective serotonin reupta%e inhibitors are currently the medications o# choice #or many psychiatrists, and
have been #or more than two decades. Kiven how completely SSGIs have saturated our culture and our environment, you might be
surprised to learn that Eli &illy, which held the .S. patent #or #luo)etine *the generic name #or rozac+, %illed the drug in
development seven times, in part because o# unconvincing test results. 9#ter e)amining the tepid outcomes o# #luo)etine trials, as
well as complaints about the drugs side e##ects, Kerman regulators in 32F concluded, D"onsidering the bene#it and the ris%, we
thin% this preparation totally unsuitable #or the treatment o# depression. Early clinical trials o# another SSGI, a)il, were also
#ailures.
Ive been on one or another SSGI pretty much continuously #or going on - years. Aevertheless, I cant say with complete conviction
that these drugs have wor%ed, at least #or long/or that theyve been worth the costs in terms o# money, side e##ects, drug$switching
traumas, and who %nows what long$term e##ects on my brain.
9#ter the initial #lush o# enthusiasm #or SSGIs in the 322s, some o# the concerns about drug dependency and side e##ects that had
attached to tran1uilizers in the 32>s began clustering around antidepressants. DIt is now clear, ?avid Healy, a historian o#
psychopharmacology, wrote in -5, Dthat the rates at which withdrawal problems have been reported on paro)etine, the generic
name #or a)il, De)ceed the rates at which withdrawal problems have been reported on any other psychotropic drug ever.
Even leaving aside withdrawal e##ects, there is now a large pile o# evidence suggesting/in line with those early studies o# the
ine##ectiveness o# rozac and a)il/that SSGIs may not wor% terribly well. In !anuary -3, almost e)actly - years a#ter hailing the
arrival o# SSGIs with its cover story Drozac7 9 8rea%through ?rug #or ?epression,#ewsweekpublished a cover story about the
growing number o# studies that suggested these and other antidepressants are barely more e##ective than sugar pills. 9 large$scale
study #rom -J showed that only about a third o# patients improved dramatically a#ter a #irst cycle o# treatment with
antidepressants. Even a#ter three additional cycles, almost a third o# patients who remained in the study had not reached remission.
9#ter reviewing a host o# studies on antidepressant e##ectiveness, a paper in the6ritish $edi%al 7ournal concluded that drugs in the
SSGI class/including rozac, Bolo#t, and a)il/Ddo not have a clinically meaning#ul advantage over placebo.
How can this be: ens o# millions o# 9mericans/including me and many people I %now/collectively consume billions o# dollars
worth o# SSGIs each year. ?oesnt this suggest that these drugs are e##ective: Aot necessarily. 9t the very least, this massive rate o#
SSGI consumption has not caused rates o# sel#$reported depression to go down/and in #act all o# this pill popping seems to correlate
with substantially higher rates o# depression. Meanwhile, the relationship between low serotonin levels and an)iety or depression
*once, and to some e)tent still, the theoretical reason SSGIs, which boost serotonin, should wor%+ now seems less straight#orward
than previously thought. Keorge 9shcro#t, who, as a research psychiatrist in Scotland in the 324s, was one o# the scientists
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responsible #or promulgating the chemical$imbalance theory o# mental illness, abandoned the theory when #urther research #ailed to
support it. D;e have hunted #or big, simple neurochemical e)planations #or psychiatric disorders, Cenneth Cendler, a co$editor o#
Psy%hologi%al $edi%ine and a psychiatry pro#essor at @irginia "ommonwealth niversity, conceded in -4, Dand have not #ound
them.
Some drugs wor% on some people, but the reasons are mur%y, and the results sometimes #leeting. =# course, studies have generally
not #ound the response rates to nonpharmacological #orms o# treatment to be better than the response rates to antidepressants or
any other drugs. Some recent studies have #ound that the e##ects o# cognitive$behavioral therapy are more enduring than drug
treatment. 8ut as a general rule o# thumb across many types o# therapy, patients tend to split pretty evenly among those who see
long$term improvement, those who see only transient bene#its, and those who see no improvement at all. *hats generally true o#
placebo treatments as well.+ 9nd so, 6ust as I #ind it di##icult to endorse most o# these treatments, I am also reluctant to condemn
them. &i%e medication, they clearly do help some patients. his is a #act I can vouch #or personally.
=n the Sunday in the autumn o# 3224 when my mother announced to him that she might want a divorce, my #ather, desperate to
save the marriage, and in a gesture that was completely out o# character, ac1uiesced to emergency couples counseling. ;hen that
didnt wor%, and my mother le#t him, he became unmoored, and soon began seeing ?r. &., my psychiatrist. or years be#ore that, my
#ather, despite #ooting the bill #or my sisters and my shrin%s, had disdained psychotherapy. DHow was your wac%o lesson: hed as%
6eeringly a#ter Id had an appointment. He did this so o#ten that the term became a part o# the #amilys lingua #ranca, and eventually
my sister and I were re#erring without irony to our wac%o lessons. *DMom, can you give me a ride to my wac%o lesson on
;ednesday:+
9nd yet, there he was, suddenly sharing a therapist with me. My own sessions with ?r. &. came to be dominated by the therapists
1uestions about his new star patient, my #ather. I couldnt blame ?r. &. #or #inding my #ather the more interesting patient. 9#ter all,
while hed been seeing me #or more than 34 years, hed been seeing my dad #or only a #ew months. My dad entered therapy
emotionally wrec%ed by his separation, pro#oundly sha%en, and newly sober. He completed therapy less than two years later, happy,
productive, remarried, and deemed *by himsel# and by ?r. &.+ to be much more Dsel#$actualized and Dauthentic than he had been
be#ore. He was in and out o# therapy in 3F months. ;hereas I was entering my 3Fth year o# therapy with ?r. &. and was still as
an)ious as ever.
9t some level, it is adaptive to be reasonably an)ious. 9ccording to "harles ?arwin *who himsel# seems to have su##ered #rom
crippling agoraphobia that le#t him intermittently housebound #or years a#ter his voyage on the6eagle+, species that e)perience an
appropriate amount o# #ear increase their chances o# survival. ;e an)ious people are less li%ely to remove ourselves #rom the gene
pool by, say, #rolic%ing on the edges o# cli##s or becoming #ighter pilots.
9n in#luential study conducted 3 years ago by two Harvard psychologists, Gobert M.
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Historical evidence suggests that an)iety can be allied to artistic and creative genius. he literary gi#ts o# Emily ?ic%inson, #or
e)ample, were ine)tricably bound up with her reclusiveness, which some say was a product o# an)iety. *She was completely
housebound a#ter age .+ ranz Ca#%a yo%ed his neurotic sensibility to his artistic sensibility0 ;oody 9llen has done the same.
!erome Cagan, an eminent Harvard psychologist who has spent more than 4 years studying human temperament, argues that
. S. Eliots an)iety and Dhigh reactive physiology helped ma%e him a great poet. Eliot was, Cagan observes, a Dshy, cautious,
sensitive child/but because he also had a supportive #amily, good schooling, and Dunusual verbal abilities, Eliot was able to
De)ploit his temperamental pre#erence #or an introverted, solitary li#e.
erhaps most #amously, Marcel roust transmuted his neurotic sensibility into art. rousts #ather, 9drien, was a physician with a
strong interest in nervous health and a co$author o# an in#luential boo% called &he (ygiene of the #eurastheni%. Marcel read his
#athers boo%, as well as boo%s by many o# the other leading nerve doctors o# his day, and incorporated their wor% into his0 his #iction
and non#iction are Dsaturated with the vocabulary o# nervous dys#unction, as one historian has put it. or roust, re#inement o#
artistic sensibility was directly tied to a nervous disposition. ?ean Simonton, a psychology pro#essor at the niversity o# "ali#ornia at
?avis who has spent decades studying the psychology o# genius, has written that De)ceptional creativity is o#ten lin%ed to
psychopathology0 it may be that the same cognitive or neurobiological mechanisms that predispose certain people to developing
an)iety disorders also enhance creative thin%ing.
Many o# historys most eminent scientists also su##ered #rom an)iety or depression, or both. ;hen Sir Isaac Aewton invented
calculus, he didnt publicize his wor% #or - years/because, some con6ecture, he was too an)ious and depressed to tell anyone. *or
more than #ive years a#ter a nervous brea%down around 3J>F, when he was in his mid$5s, he rarely ventured #ar #rom his room at
"ambridge.+ erhaps i# ?arwin had not been largely housebound by his an)iety #or decades on end, he would never have been able
to #inish his wor% on evolution. Sigmund reuds career was nearly derailed early on by his terrible an)iety and sel#$doubt0 he
overcame it, and once his reputation as a great man o# science had been established, reud and his acolytes sought to portray him as
the eternally sel#$assured wise man. 8ut his early letters reveal otherwise.
Ao, an)iety is not, by itsel#, going to ma%e you a Aobel rizePwinning poet or a groundbrea%ing scientist. 8ut i# you harness your
an)ious temperament correctly, it might ma%e you a better wor%er. !erome Cagan says he hires only people with high$reactive
temperaments as research assistants. Dheyre compulsive, they dont ma%e errors, he told &he #ew York &imes. =ther research
supports Cagans observation. 9 -35 study in the%ademy of $anagement 7ournal, #or instance, #ound that neurotics contribute
more to group pro6ects than co$wor%ers predict, while e)troverts contribute less. 9nd in -4, researchers in the nited Cingdom
published a paper, D"an ;orriers 8e ;inners:, reporting that #inancial managers high in an)iety tended to be the best, most
e##ective money managers, as long as their worrying was accompanied by a high IR.
$y anxiety %an be intolerable. 6ut it is also, maybe, a gift3or at least the other side of a %oin I ought to think twi%e about beforetrading in.
n#ortunately, the positive correlation between worrying and 6ob per#ormance disappeared when the worriers had a low IR. 8ut
some evidence suggests that e)cessive worrying is itsel# allied to intelligence. !eremy "oplan, the lead author o# one study
supporting that thesis, says an)iety is evolutionarily adaptive because Devery so o#ten theres a wild$card danger. ;hen such a
danger arises, an)ious people are more li%ely to be prepared to survive. "oplan, a pro#essor o# psychiatry at the State niversity o#
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ta%en early in li#e #rom their an)ious mothers and given to unan)ious mothers to be raised, a #ascinating thing happened7 these
mon%eys grew up to display less an)iety than peers with the same genetic mar%ings/and many also, intriguingly, became the leader
o# their troop. his suggests that, under the right circumstances, some 1uotient o# an)iety can e1uip you to be a leader.
9s always, all o# this comes with the proviso that an)iety is productive mainly when it is not so strong as to be debilitating. 8ut i# you
are an)ious, perhaps you can ta%e heart #rom these #indings.
Ive come to understand that my own nervous disposition is perhaps an essential part o# my being/and not 6ust in ways that are bad.
DI hate your an)iety, my wi#e once said, Dand I hate that it ma%es you unhappy. 8ut what i# there are things that I love about you
that are connected to your an)iety:
D;hat i#, she as%ed, getting to the heart o# the matter, Dyoure cured o# your an)iety and you become a total 6er%:
I suspect I might. Military pilots, by reputation, at least, are #amously unan)ious. 9nd one small$scale study #rom the 32Fs #ound
that nine out o# 3 separations and divorces among 9ir orce pilots were initiated by wives. erhaps the two are lin%ed. &ow baseline
levels o# autonomic arousal *which can correspond to low levels o# an)iety+ have been tied not only to a need #or adventure *#lying a
#ighter plane, say+, but also to a certain interpersonal obtuseness, a lac% o# sensitivity to social cues. It may be that my an)iety lends
me an inhibition and a social sensitivity that ma%e me more attuned to other people and a more tolerable spouse than I otherwise
would be.
he notion o# a connection between an)iety and morality long predates the #indings o# modern science or my wi#es intuition. Saint
9ugustine believed #ear is adaptive because it helps people behave morally. he novelist 9ngela "arter has called an)iety Dthe
beginning o# conscience. Some research into the determinants o# criminal behavior suggest that criminals tend to be lower in
an)iety than noncriminals. *=n the other hand, di##erent studies have #ound that high levels o# an)iety, especially in youth, correlate
with delin1uent behavior.+
My an)iety can be intolerable. 8ut it is also, maybe, a gi#t/or at least the other side o# a coin I ought to thin% twice about be#ore
trading in. 9s o#ten as an)iety has held me bac%/prevented me #rom traveling, or #rom seizing opportunities or ta%ing certain ris%s
/it has also un1uestionably spurred me #orward. DI# a man were a beast or an angel, he would not be able to be in an)iety, SOren
Cier%egaard wrote in 3F. DSince he is a synthesis, he can be in an)iety, and the greater the an)iety, the greater the man. I dont
%now about that. 8ut I do %now that some o# the things #or which I am most than%#ul/the opportunity to help lead a respected
magazine0 a place, however peripheral, in shaping public debate0 a peripatetic and curious sensibility0 and whatever 1uotients o#
emotional intelligence and good 6udgment I possess/not only coe)ist with my condition but are in some meaning#ul way the
product o# it.
In his 323 essay Dhe ;ound and the 8ow, the literary critic Edmund ;ilson writes o# the Sophoclean hero hiloctetes, whose
suppurating, never$healing sna%ebite wound on his #oot is lin%ed to a gi#t #or unerring accuracy with his bow and arrow/his
Dmalodorous disease is inseparable #rom his Dsuperhuman art #or mar%smanship. I have always been drawn to this parable7 in itlies, as the writer !eanette ;interson has put it, Dthe nearness o# the wound to the gi#t, the insight that in wea%ness and
shame#ulness is also the potential #or transcendence, heroism, or redemption. My an)iety remains an unhealed wound that, at times,
holds me bac% and #ills me with shame/but it may also be, at the same time, a source o# strength and a bestower o# certain blessings.
Scott Stossel is the editor o# &he tlanti%and the author o#/arge8 &he 9ife and &imes of /argent /hriver.his essay is adapted #rom
his new boo%,$y ge of nxiety8 *ear, (ope, 4read, and the /ear%h for Pea%e of $ind,to be published !anuary > by Cnop#.
http://www.amazon.com/Sarge-Life-Times-Sargent-Shriver/dp/1588341275http://www.amazon.com/Sarge-Life-Times-Sargent-Shriver/dp/1588341275http://www.amazon.com/My-Age-Anxiety-Dread-Search/dp/0307269876http://www.amazon.com/My-Age-Anxiety-Dread-Search/dp/0307269876http://www.amazon.com/My-Age-Anxiety-Dread-Search/dp/0307269876http://www.amazon.com/Sarge-Life-Times-Sargent-Shriver/dp/1588341275http://www.amazon.com/My-Age-Anxiety-Dread-Search/dp/0307269876