1.
Meet Scott Hanford Stossel, an accomplished man in his mid-40s with two young kids, a solid marriage, and a job as editor of a prestigious magazine. A graduate of Harvard, Stossel is popular among his friends and admired by colleagues. At the same time, and to a pathological degree, he is a man riddled with angst. And, for him, it has ever been thus.
Since he was two, Stossel recalls being a “twitchy bundle of phobias, fears, and neuroses.” He was a head-banging, tantrum-throwing toddler. On school days, his parents pried him, screaming bloody hell, out of the car and into the classroom. At age 10 he met the psychiatrist who would treat him for the next 25 years. Seventh grade brought a full-on melt down necessitating Thorazine. Over the years, he’s endured a Job-like onslaught of phobias including fears of vomiting and fainting, of flying, of heights, of germs, and, curiously, cheese.
Life for Scott Stossel has been a gauntlet of morbid what-ifs: what if I pass out, lose control of my bowels, bolt from the podium in the midst of a speech?
To keep such mayhem at bay, he’s medicated himself with bourbon, scotch, gin, and vodka. By prescription, he has taken Klonopin, Xanax, Ativan, Imipramine, Wellbutrin, Nardil, Thorazine, Zoloft, Effexor, Paxil, and Propranolol, among others. “A living repository of all the pharmacological trends in anxiety treatment of the last half century,” is how the author describes himself.
Then, of course, there were therapies. He’s undergone psychodynamic psychotherapy, cognitive behavioral therapy, rational emotive therapy, exposure therapy, hypnosis, meditation, biofeedback, role-playing, eye movement desensitization and reprocessing, acupuncture, yoga, and meditation. One doctor tried, a la Clockwork Orange, to help him conquer his terror of vomiting by administering a nausea-inducing drug.
Nothing worked.
So Stossel enlisted his talent as a writer. “Maybe by tunneling into my anxiety for this book I can also tunnel out the other side,” he hopes. Did he make it? Not quite, “My anxiety remains as unhealed wound.” But while My Age of Anxiety has apparently fallen short of its intended therapeutic goals, it is — for the rest of us — a meticulously researched cultural and scientific biography of a mental affliction featuring the author as one very, very hard case.
2.
Illness memoirs satisfy two human imperatives. The first is voyeurism. Sick-lit, as it’s been called, incites a kind of literary rubber-necking. We’re drawn to tales of once-behaved cells ravaging organs, of accidents that crumple the bones, of strokes that lead us to mistake our spouses for headgear. In most of these stories, the author emerges scarred but wiser. Illness narratives also foster readers’ identification with the afflicted. This can be invaluable to people suffering from the same condition. They want to know they are not alone. They want to prepare for the worst, to cope in better ways, to learn more about their illness.
The illness memoir thrives on gory detail. My Age of Anxiety is no exception; Stossel even frets that he’s gone overboard. “I worry that the book, with its revelations of anxiety and struggle, will be a litany of Too Much Information, a violation of basic standards of decorum and restraint.” That’s understandable, but such intimacies are needed; they nourish the reader’s empathy for the sufferer. And when the malady happens to be unbounded anxiety — a syndrome of outsize reactions to threats that aren’t really there — we can learn a lot about the author: his vulnerabilities, the kinds of certainties he craves, and the morbid reaches of his imagination.
On the lighter side, anxiety can be funny. It is the stuff of frantic shtick, stand-up comedy, and Woody Allen. Depression, by contrast, makes darkness visible. It thrives on isolation and rumination; its muse is Ingmar Bergman. As for psychosis, it’s just too alien to be amusing.
Here is Andrew Solomon in Noonday Demon, his memoir cum biography of depression:
Depression is the flaw in love. To be creatures who love, we must be creatures who can despair at what we lose, and depression is the mechanism of that despair.
Here is William Styron, author of Darkness Visible, his memoir of depression:
My brain had begun to endure its familiar siege: panic and dislocation, and a sense that my thought processes were being engulfed by a toxic and unnameable tide that obliterated any enjoyable response to the living world.
Here is Stossel:
As is so often the case with irritable bowel syndrome, it was at precisely the moment I passed beyond Easily Accessible Bathroom Range that my clogged plumbing came unglued. Sprinting back to the house where I was staying, I was several times convinced that I would not make it and –teeth gritted, sweating voluminously — was reduced to evaluating various bushes and storage sheds along the way for their potential as ersatz outhouses. Imagining what might ensue if a Secret Service agent were to happen upon me crouched in the shrubbery lent a kind of panicked, otherworldly strength to my efforts at self-possession.
A Secret Service agent? Evidence of paranoia? No. This incident, it turns out, took place on the Hyannisport property of the Kennedy family. Over a decade ago, Stossel had spent time with the Kennedys as he researched a biography of Sargent Shriver. The episode continues, bordering on slapstick. When Stossel reached the bathroom, he “flung” himself onto the toilet (“my relief was extravagant,” he writes, “almost metaphysical”). Then all hell breaks loose. The toilet malfunctions, spewing sewage about the room and on his clothes. Our humble narrator strips, and, as he sprints to his room clad only in a bathroom towel tied at the waist, encounters JFK Jr. in the hallway. The latter is unfazed.
Stossel portrays his own ordeals with good humor, but he treats his family soberly. A. Chester Hanford, dean of students at Harvard College from 1927 to 1947 was always “nervous,” says Stossel, his great-grandson. The future dean told his young wife that he half-hoped to be drafted for combat during WWI as “dodging bullets on a battlefield would certainly be less wrenching than having to lecture undergraduates.” (Notably, as Stossel points out, anxious people are much better at handing fear — real threats — than they are at managing imaginary dangers; in fact, they often do a better of it than normal folks.)
When Dean Hanford turned 50, he cracked. The deaths of colleagues in World War II and the demise of his best friend weighed on him. Flagellated by self-doubt, given to fits of uncontrollable weeping, and, finally, suicidal, he entered McLean Hospital in Belmont, Mass. Until his death almost 30 years later Hanford would undergo many hospitalizations. Other relatives bore the curse. Stossel’s mother, the granddaughter of the dean, was perpetually high strung; his sister has been treated with a range of anti-anxiety medications.
“Does my heredity doom me to a similar downhill spiral [as my great-grandfather] if I am subjected to too much stress?” Stossel wonders. And does it endanger his children? “For Maren and Nathaniel — May You Be Spared,” he writes in the dedication. Already, however, there are signs. His small son has serious separation-anxiety. His eight-year old daughter, like her father and grandmother before her, is saddled with an obsessive fear of vomiting. “Have I — despite my decades of therapy, my hard-won personal and scholarly knowledge of anxiety, my wife’s and my informed efforts at inoculating our children against it — bequeathed to Maren my disorder, as my mother bequeathed it to me?” the author asks. The answer resides in the nature of anxiety itself.
3.
Anxiety is the descendant of fear, our most primitive emotion. The arousal system instantly mobilizes organisms to defend against threat and, like any biological system, it can go awry. In so-called generalized anxiety disorder, a person exists in a chronic state of vigilance, ready to flee if need be. (Or, in the words of Freud, “Atrophied remnants of innate preparedness [as is] so well-developed in other animals.”) Individuals who suffer panic attacks feel as if they are suffocating. Presumably, specific neural mechanisms are hypersensitive and triggered by elevated but otherwise benign concentrations of carbon dioxide in the bloodstream (from situations such as rapid breathing or discomfort at being in a crowd) as pending asphyxiation.
Stossel suffered not only from these conditions but also from social phobia wherein a person is fearful of interacting with strangers lest he be rejected or humiliated by them. Some evolutionary theorists trace this glitch to the demands of hierarchical societies. That is, one had better be attuned to what others think of them or risk upsetting the social order of the tribe. As for the author, he suspects that that his social phobia has caused him to be a nice person. “[I]t may be that my anxiety lends me an inhibition and a social sensitivity that makes me more attuned to other people.”
Stossel’s own therapist dismissed the natural-functions-gone-wild hypothesis of clinical anxiety and put his money on existential crises as its engine. We grow old and die; lose loved ones; risk failure and humiliation; search unrequitedly for love and meaning. Anxiety is the shield we use to ward off the sadness and pain these inevitabilities bring, he tells Stossel. If he is right, the question then becomes why only some of us come undone in the face of these looming prospects.
For answers, Stossel is partial to the laboratory. He likes neuroscientists’ explanations of anxiety as excessive “neuronal firing rates in the amygdala and locus coeruleus.” The psychopharmacologists’ view of anxiety as the “inhibition of the glutamate system,” and geneticists’ errant “single-nucleotide polymorphisms” rightly strike him as “scientific and more convincing” than his therapist’s existential account. But they also raised questions:
Can my anxiety really be boiled down to how effectively gated my chloride ion channels are or to the speed of neuronal firing in my amygdala? Well, yes, at some level it can. Rates of neuronal firing in the amygdala correlate quite directly with the felt experience of anxiety. But to say that my anxiety is reducible to the ions in my amygdala is as limiting as saying that my personality or my soul is reducible to the molecules that make up my brain cells or to the genes that underwrote them.
“Shouldn’t this be liberating?” Stossel asks. “If being anxious is genetically encoded, a medical disease, and not a failure of character or will, how can we be blamed, shamed, or stigmatized for it? Eventually, he snapped out of this reductionistic reverie, reminding himself that “The same building blocks of nucleotides, genes, neurons, and neurotransmitters that make up my anxiety also make up my personality.” And his was a personality that accepted challenges, honored commitments, and excelled academically and professionally.
Finally, anxious habits can be learned. Here, the author’s mother taught a master class. This proper Mayflower descendant was chronically terrified of vomiting. Through her own doom-mongering and over-protectiveness, she inspired the author to spin out worst-case scenarios. Perhaps this is why Stossel holds such great store by the great Stoic Epictetus, who observed that “People are not disturbed by things but by the view they take of them.” From a young age, his mother taught him to take the dimmest possible one.
Though he treats her sympathetically — like his great grandfather, she is a tormented soul — he credits her with reducing him and his sister to “states of neurotic dependency.” His physician father, a depressive drinker, contributed the author’s boyhood shame (“You twerp, you pathetic little twerp”). Said a therapist from his adolescent days whom Stossel tracked down, “Your parents — an anxious, overprotective mother and emotionally absent father– were a classically anxiety-producing combination.”
“Thus me,” Stossel pronounces, “a mixture of Jewish and WASP pathology — a neurotic and histrionic Jew suppressed inside a neurotic and repressed WASP. No wonder I am anxious: I’m like Woody Allen trapped in John Calvin.”
So, what is anxiety? Stossel’s answer risks sounding evasive, but in the context of his rich book, is true and inevitable. It “is at once a function of biology and philosophy, body and mind, instinct and reason, personality and culture,” he concludes. “In computer terms, it’s both a hardware problem (I’m wired badly) and a software problem (I run faulty logic programs that make me think anxious thoughts).”
4.
In 2004, the World Health Organization conducted a mental health survey of 18 countries including the U.S., China, the Netherlands, and Italy. It found anxiety disorders to be the most common form of mental condition on earth. According to a 2009 report called “In the Face of Fear,” England’s Mental Health Foundation, anxiety has been detected at “record levels.” Does this mean that we really do live in an age of anxiety.
And if so, why? After all, ours is an age of unprecedented material prosperity and well-being in the industrialized West. Life expectancies are, for the most part, long and growing. On the other hand, progress, itself, may be the culprit. For all their glories, growth of the market economy, increases in geographic and class mobility, the spread of democratic values and freedoms, carry their own perils — namely, panoply of choices. Within bounds, we are relatively free to choose where we live, whom we marry, and what we aim to be.
Finally, we are now quicker to pathologize the vagaries of everyday life. And, in trigger-happy hands, the official psychiatric manual can be a set of diagnoses in search of patients.
It’s hard to know. “There is no magical anxiety meter that can transcend the cultural particularities of place and time to objectively measure levels of anxiety,” the author wisely observes. What we do know is that some relatively fixed proportion of humanity has always been more anxious than others. Authoritative voices, observers and sufferers both, attest to this. Hippocrates (anxiety as “worries exaggerated in fancy”), Robert Burton, author of the magisterial The Anatomy of Melancholy in 1621, Charles Darwin (for years was too agoraphobic to leave the house), Søren Kierkegaard (he dubbed anxiety the “terrible torture” of Grand Inquisitor), Thomas Jefferson (posthumously diagnosed as a social phobic), Sigmund Freud (observer), Virginia Woolf (sufferer), William James (observer and sufferer), Mahatma Gandhi (public speaking), Barbra Streisand (crippling stage fright), and, last but not least, Donny Osmond, spokesperson for the Anxiety and Depression Association of America.
A different conception of anxiety — more a cultural affliction than a clinical scourge — was forged in the post WWII period. In his 1947 epic book-length poem called The Age of Anxiety, W.H. Auden described man as “unattached as tumbleweeds,” on a quest to find substance and identity in an increasingly industrialized world. The poem inspired Leonard Bernstein to write a symphony and Jerome Robbins to produce a ballet. A year later, historian Arthur M. Schlesinger Jr. proclaimed Western man looks “upon our epoch as a time of troubles, an age of anxiety…our familiar ideas and institutions vanish as we reach for them, like shadows in the falling dusk.”
This existential angst, some historians suggests, embodied a consciousness that led to America’s tranquilizer culture. In 1955, Carter Products began marketing Miltown for nerves, tension, and, insomnia, but the company was pessimistic that psychiatrists would prescribe it. Freud was ascendant in American psychiatry at the time and theory dictated that treating specific symptoms was of little clinical value. Be it depression, anxiety, or psychosis — all clinical presentations were taken to be interchangeable markers of deeper psychodynamic misfortunes. Still, Miltown was somewhat safer than barbiturates (e.g., Seconal, Nembutal, and Amytal) currently in use. The latter were highly addictive, produced brutal withdrawal syndrome, and were lethal if a person accidentally took just one too many.
To the manufacturer’s great surprise, Miltown became the best-selling drug ever marketed in the country. It was the first lifestyle drug for the stressed-out, can-do corporate man and his put-upon spouse as well as for celebrities. The comedian Milton Berle, for example, introduced himself as “Miltown Berle.”
Researchers were excited too. Miltown (along with Thorazine, a novel anti-psychotic introduced in the U.S. in the mid-’50s) contributed to a wholesale transformation of the way we think about mental illness. It meant that mental illness was brought on by deranged brain biology, not by Oedipal dramas, and thus corrected with medicine.
Soon, though, there was trouble in paradise. By the late 1950s, Miltown, too, revealed itself to be habit-forming. As sales began to fall off, Valium-type drugs, a class of tranquilizer called benzodiazepines, rushed in to fill the vacuum. But, as before, chemical infatuation gave rise to disenchantment. In the mid seventies the FDA had amassed reports of benzodiazepine dependence and withdrawal. Prozac, too, once kicked off a revolution. But within a few years of its release in 1988, Prozac (which also gained FDA approval to treat panic disorder) lost its luster.
Now, the golden age of psychopharmaceuticals is drawing to a close. Most of the major drug firms have curtailed or shuttered their drug discovery labs. The pipeline to the FDA is running dry. Despite this depressing picture, psychiatrists are optimistic that new approaches will eventually prove fruitful — the question is how soon.
In the meantime, current medications — which continue to be prescribed in record volumes — are often extremely helpful. Psychological and behavioral therapies are indispensible too. Some patients do very well and even the author found some relief, but not nearly enough.
And what of the writing cure? “[I]n finishing this book, albeit a book that dwells at great length on my helplessness and inefficacy, maybe I am demonstrating a form of efficacy, perseverance, productivity — and yes, resilience,” Stossel writes. Indeed, he’s done all those things and more. He’s produced an excellent synthesis of reportage, research, and personal revelation. We are the beneficiaries of his self-imposed therapy. But the patient-author still ails, not being able, he says, to “escape my anxiety or be cured of it.”
Yet with a condition so encompassing and of such long standing, could he ever strip the “real” him from his disease? From the beginning, fear and Stossel were born twins. One wonders if he would ache for that phantom creature if, somehow, it were excised.
