Stossel Surviving Anxiety the Atlantic Jan-Feg 2014

8/12/2019 Stossel Surviving Anxiety the Atlantic Jan-Feg 2014

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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#

Aew


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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

Documents

Stossel Surviving Anxiety the Atlantic Jan-Feg 2014