Americans are an anxious people.
About one in five of us suffers from an anxiety disorder, and in their most serious manifestations they can be devastating, leading to everything from severe agoraphobia to dangerous substance abuse. There is, as always, controversy over how to best treat anxiety; depending on which expert you ask, you could be pointed toward medication, talk therapy, meditation, or some combination of all the above.
For those of us who suffer from anxiety (and I would certainly put myself in that category, although at the milder end—I don’t have any official diagnosis and am medication-free), it can be hard to explain the symptoms to our non-anxious friends and family. It’s difficult to imagine lying awake at 3 a.m. obsessing night after night, or being plagued by constant thoughts of spectacular failure, or suffering a panic attack, if you yourself have not experienced these symptoms firsthand.
That’s part of the reason My Age of Anxiety: Fear, Hope, Dread, and the Search for Peace of Mind, by Scott Stossel, editor of The Atlantic, is such a wonderful book. In a work that is part memoir, part medical history, part contemporary examination of American psychology and psychiatry, Stossel deftly relates his own often crippling experiences with anxiety, some of which are simultaneously heartbreaking and hilarious. He approaches topics like the pharmaceutical industry and the connection between anxiety and childhood experiences with extreme nuance and sophistication, often raising more questions than answers—which is exactly what the result should be when an author dives into a topic as complex and fraught as the human brain.
Stossel recently spoke with The Daily Beast over Skype. An edited transcript follows.
Let’s start with panic attacks, which are always fun. I’ve had them and they were some of the most scary and miserable experiences of my life. Your description of them struck me. It seemed like a microcosm of this whole issue of losing your faith in your body’s ability to keep things together, this fear of everything unraveling on the street or in a movie theater or anywhere else. It seems like a hard thing for an anxious person to explain to a non-anxious person.
It really is this sensation that both your kind of physiology and your thought processes have been hijacked by the panic. People experiencing their first panic attack often end up in emergency rooms thinking that they’re having a heart attack or dying or something because they just don’t know what’s wrong with them. And the systems actually do overlap the symptoms of a heart attack: heart pounding, sweating and nausea, dizziness and just feeling overwhelmingly awful.
Even for those of us who’ve experienced hundreds or thousands of them over the years, even when you think you know, even when you completely know that it’s a panic attack, you know you’re not dying, and yet somehow still the feeling of all-consuming dread and physical awfulness is pretty overwhelming even though you logically know that you’re not going to die, there’s nothing significantly medically wrong with you.
In the book you transcribed this whole internal dialog with yourself where no matter how many times this happened, no amount of intellectualizing can convince your body that you’re not dying, that it’s just a panic attack and it will pass like all the others before it.
Right. And some that you sort of can, and I can sort of head it off at this pass. There are people who with breathing techniques, sort of self-taught, can actually cure themselves of them or head them off at the pass. And I can sometimes do that, and sometimes I can sort of restrict it to having anxious symptoms like dizziness and vertigo, and it doesn’t tip over into full-blown panic. And yet other times, it just does.
Speaking of breathing techniques, I’ve noticed that there wasn’t much in the book about mindfulness meditation, which is really hot right now as a means of improving mental health. Whenever I’ve tried to do it, I’ve failed completely. Is it something you’ve tried? Was there a reason for that omission?
In an earlier draft I had a brief section at the end where I listed everything that I gleaned about what works for mitigating and treating and sometimes curing anxiety. And that was definitely high on the list. We ended up cutting it just for space; it didn’t really fit with the flow.
But two responses to that. One is that yes, the little bit that I have in the book and almost everything that I have read suggests that there is increasingly compelling evidence piling up in research laboratories all over the country about the effectiveness of mindfulness meditation.
In the book I do mention, in passing, this one study that was really striking where they had a bunch of sort of novice meditaters and they had them practice for like 28 days, and after the 28 days, their self-reported levels of well being went up and levels of anxiety went down. And then you put them in a FMRI machine and the size of amygdalae actually shrinks, and there is tons of research like that.
The second point I’ll make is that my experience has been like yours. I have tried, over the years, different forms of this and I think it’s like with yoga; the people who most need it and would most benefit are the ones that have the hardest time doing it. The same thing with yoga, it’s like standing in some position that’s incredibly complicated so it’s discouraging. But I do think that mindfulness meditation is very promising and I continue to try to make little forays into it.
You write that on the one hand it was heartbreaking seeing your kids manifest some of the same nervous tendencies you have, but also that they seem to be getting a little bit better as of when you wrote the book. Did you think that because of your own struggle, you were in a better position to console them and steer them toward treatment?
I hope so, yeah. Having, again, read a lot of literature and talked to some of the psychologists, we knew the importance of early intervention. So getting to my daughter when she was 7 and my son when he was even younger was really, really important. So I definitely had more sympathy and understanding than I think my parents had. Even though my mom herself was anxious, I think she didn’t know how to deal with it in her kid, and my dad just had no conception of what this was about, and sort of didn’t even want to acknowledge it. So I think that that probably did help in my kids’ case.
The cognitive behavioral therapy that my daughter, who’s now 10, went through was highly effective. The sort of joke in our family is that her phobia’s less acute than mine. I have some concern that because I’ve now come out about this and have written a whole book about it, anxiety as a topic is big in our household and there’s some danger that that will seep into them via power of suggestion. I don’t want to see anxiety everywhere if it’s not there. But the short answer is yes, I think it was beneficial to have had my experience and all the research I had done to mitigate the problem with my kids.
Yeah, there is that… at the risk of invoking stereotypes, I’m Jewish. You’re half-Jewish, right?
There’s that tendency or stereotype of just within the family endlessly ruminating over what’s wrong with whom and how to fix it. Isn’t there some research that talking about this stuff or venting about it can only have mixed results? How do you deal with that tendency to want to talk about it all the time and sort of self-diagnose?
I think the research runs in different directions depending on the nature of the remission. Yes, obsessing about problems is itself like a symptom of anxiety and generally not productive. On the other hand, suppressing emotion can also be counterproductive, so there’s probably a happy medium in there somewhere. For me, again I don’t know if this makes me a typical Jewish hypochondriac or just a typical hypochondriac, period, but I worry about my own health symptoms. And then when you have kids, you find that your hypochondria can can extend not just to the limits of your own body but to them. Any time there’s a bump on my kid’s head or their fever lasts more than a day, I’m convinced that they’ve got cancer or malaria or something.
I couldn’t help but laugh at the part of the book where your then-therapist asked you to write a worst-case scenario about some career juncture, and then she reads it and is so disturbed she has to summon her supervisor. So it sounds like, to a certain extent, you’ve accepted the fact that you’re out at the tail end of the anxiety and negativity distribution, but what’s the process like of trying to accept that? Because it sounds like you’re at a point where you don’t think you’re ever going to be a happy-go-lucky guy.
I think it’s funny. I’ve had discussions with my therapist Dr. W, the character in the book. He continues to believe no, no, you can actually be not completely cured, but substantially cured. My own feeling is that I’m sort of hard-wired at some level to have a genetically, biologically high-reactive temperament, as Jerome Kagan and the Harvard psychologists would say. That’s always going to be true. But various sort of coping techniques and medication help. There are lots of things, including changing the kind of inner dialog, that can mitigate anxiety. And yes, there are people who have the glass half full and glass half empty, and I’m afraid the glass is going to break and I’ll cut myself on the shards.
Along those lines, at the end of the book you go to your old therapist and it sounds like he’s more or less encouraging you to give yourself a break, to find some forgiveness for yourself and say, “Okay, I’ve dealt with this thing my whole life, I’ve exhibited some resilience to adversity.” What is it about all the rumination, all the anxiety that makes it so hard to sort of stand up for yourself, to yourself?
We talked a lot about the gap between our appearances and perception. I’ve held a job for 30 years and have had generally moderate professional success and no catastrophic failures, and yet somehow that doesn’t always feel like it aligns with my inner sense of worry, anxiety, and rumination. It’s actually my current therapist, Dr. W., who is saying, “You need to recognize that you have exhibited resilience through all of these things.” It is true that simply completing this book under sometimes difficult circumstances, was an act of—I don’t know of resilience, but of persistence—and demonstrates that I am able to persevere through these things.
And I’m having this conversation within the context of my great grandfather, who I talk about in the book. He was a very professionally successful guy, a Dean of Harvard College who clearly, I now know from looking at his medical records, wrestled with chronic worry and anxiety throughout his whole career and got into his 50s and suddenly just broke down. I’m sort of haunted by that question: “Is that my future?” And Dr. W’s points are, “No, you’re two different people,” and that I also have access to modern medication that he didn’t. He was taking the medications of his day but they were less effective.
Dr. W.’s like, “You’ve dealt with a lot of stress and strain, and if you were going to crack, you would have and you actually are resilient.” So I’m trying to internalize that but the fragility I feel: I believe myself more than him. I’m trying to believe him more.
You also wrote a little bit, I’d almost say despairingly, that this process of looking back at our childhoods and trying to figure out basically what screwed us up there is “endlessly recursive.” We sort of highlight this or that event and obsess about it, but there’s no real way to draw one-to-one connections between what happened then and who we are now, there’s no way to draw counterfactuals. What should be the right place for this kind of psychological archaeology? There’s got to be some stuff we can learn from our childhoods, right?
Yeah, and it’s funny: like you say, you can’t run controlled experiments with yourself in a counterfactual, so all of these things feed into it. My own conclusion, tentatively based on all of the reading that I’ve done, is that there is a large component of one’s general predisposition to anxiety, or to not having anxiety, that is genetically not completely predetermined but sort of hard-wired. And then overlaid on that, obviously I think Freud and John Bowlby and generations of psychiatrists are not wrong that early childhood experiences, in particular your relationship with your parents, has a profoundly formative effect that is sort of overlaid on top of whatever your genome is. Especially if you’re exposed to severe trauma of any kind.
I was not. My parents were not perfect but no one’s parents are. As childhoods go, mine was pretty comfortable and good in a lot of ways, and yet I still ended up with anxiety. So there’s trauma and then there’s life circumstances and stress. And yeah, it’s hard to know, when someone gives in to anxiety or when a phobia or a panic rises out of control, what is the contributing factor? You can still find experts and psychiatrists who say it’s a purely a medical, biological malfunctioning problem. If they see a client with a suffocation alarm response that’s misfiring, you can just medicate that away. And others will say, “No, no, it’s unresolved psychic conflicts that you just need to bring up from your unconscious and once you resolve them, the anxiety will clear.”
I think those are both true to some degree. What’s fascinating is that despite all of this cutting-edge neuroscience and genetic research into anxiety, we’re really still pretty early in the research into all this. We’re still groping around in the dark. In 100 or 1,000 years people may look back and think that some of this phrenology, where we’re, like, reading the bumps in your head to determine personality, but it’s still really interesting that is yielding all kinds of insights.
So I know it’s tough—you’re a testament to the fact that it can take decades to sort out anxiety issues—but from all your research, from all the papers you’ve read, do you have any advice for folks who are hamstrung by anxiety but don’t have resources you did to learn about it or get as much treatment as you did?
Yeah, a couple things. One is that there’s a resource called the Anxiety and Depression Association of America, or ADAA. They’re nonprofit, they’re not affiliated with any particular theory or school, so it’s basically just a resource that serves as a clearinghouse for research on the topic. But it’s also for patients: if you go to adaa.org, if you or someone you know is suffering from this and just don’t know where to get help or want to learn more about the conditions, you can go there and they’ll help hook you up with a therapist. So that’s one resource.
The cutting edge thinking these days does tend to be, as you mentioned earlier, on this mindfulness meditation. And for many individual phobias and even things like general anxiety and insomnia, cognitive behavioral therapy or CBT can get good results. CBT is just basically a time-limited period working with a therapist to expose yourself to the things that you’re afraid of: in the case of anxiety, experiencing anxiety and learning that you can cope with it and then reframing your thought process around it. A lot of evidence shows to be very, very effective for many people and as effective or more effective than medication, but without the problems of side effects and dependency and all that.
And then, for people who have severe distress, there’s obviously medication. I have complicated views on medication. Obviously people have views all over the map on that. But I do think, at the very least, it can be essential in controlling the most severe symptoms of anxiety, and I think it’s a necessary and useful part of the psychotherapist’s arsenal. No one can predict which medications will work for which people but for people who are in extreme distress, it’s an option they should not be afraid to consider.
Like the Q&A? Purchase My Age of Anxiety: Fear, Hope, Dread, and the Search for Peace of Mind on Amazon.