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.

Styron 

Faced with the prospect of a plane trip or a speaking engagement or sometimes even a squash match or a meeting at the office, Stossel experiences full-blown panic: insomnia, sweating, vertigo, stomach pains, and loss of control of his bowels.




People describe themselves as excited, nervous, apprehensive, tense, stressed out, bugged, worried, panicky, vapor-locked, scared shitless, sick to their stomach, and feeling like they’re gonna die. Each of these moods is arguably a form of anxiety, but they are experienced as very different affective states. All sorts of events in life make us feel keyed up. The brain states may be similar, but the adrenaline rush we experience when we mount the stage to accept the Oscar for Best Actress does not seem to have much in common with a cheese phobia.





What makes the business even more confusing is that anxiety is hard to distinguish clinically from depression. We picture anxious people as hyper and overreactive, and depressed people as lethargic and indifferent. But depression, too, can be understood as a response to a perceived or imagined threat, and antidepressants like Prozac and Effexor also alleviate anxiety.




After twenty-five years, Stossel changed psychiatrists. He is now with Dr. W., who appears to be a humanist-existentialist practitioner—a school of psychiatry of which Rollo May is one of the founders. A big question in the treatment of mood disorders is how seriously to take the patient’s own reasons for feeling anxious or depressed. If the disorder is a neurochemical disturbance, then the patient’s stories about his or her problems may just be the mood talking. If you can make the mood disappear, then the problems will disappear. But those stories aren’t completely made up. Dr. W.’s assumption, as Stossel explains it, is that although cheese and vomiting are not life-threatening, there is a traumatic or psychically wounding event that underlies anxiety about them. As Stossel puts it, the theory is that anxiety arises from “failed efforts to resolve basic existential dilemmas.” The goal of therapy is to address those dilemmas by getting back to the original hurt.





How effective were these trials? Stossel’s description of his life during the time he was writing the chapter on drugs can serve as a commentary: “Many nights I would begin the evening fueled by caffeine and nicotine, which I needed to propel me out of torpor and hopelessness—only to overshoot into quaking, quivering anxiety. Thoughts racing, hand shaking, I would end the evening taking a Klonopin and then perhaps a Xanax and drinking a Scotch (and then another and another) to settle down. This is not healthy.” That’s an understatement.

One way in which anxiety differs from depression is that anxious people are often not dysfunctional. William Styron wasn’t able to write “Darkness Visible” when he was clinically depressed; Andrew Solomon had to get over his depression to be able to write his marvellous book “The Noonday Demon.” Though Stossel’s disorder must have made progress painful, he does not appear to have been in remission when he wrote “My Age of Anxiety.”

Whether or not this has something to do with the beneficial aspects of anxiety—it focusses the mind and prepares the body for action (in extreme cases, by evacuating the bowels)—there are many successful people who, like Stossel, have managed to cope with serious phobias and nervous disorders. He discusses a number of them. Charles Darwin suffered from a social anxiety that frequently made it impossible for him to leave his house.





Nerves are a mystery. Some people seem to have none. We admire these people for their pluck, but, really, they are just born lucky. Other people have agoraphobia (fear of public spaces) but are courageous in battle. Most of us have minor performance and social anxieties that stop as soon as we get in front of the microphone or realize that the strangers at the party are no less uninteresting than we are. Our brain shuts off the release of cortisol (the stress hormone associated with the fight-or-flight reflex) and other chemicals that were making us feel anxious. We have evacuated our psychic bowels. We are in the present and in control. We feel good—or, at least, we no longer feel like we’d rather be dead.




In normal life, anxiety has content. It’s not merely a somatic reflex. Bill Russell’s anxiety tells us something we otherwise wouldn’t know about Bill Russell. It tells us how he felt about what he did for a living. Anxiety like Russell’s is triggered by a conscious thought about a present or future circumstance. It is scary to compete in public against talented people who would love nothing more than to make you fail, just as it’s scary to be in an airplane in a thunderstorm or to have a monster under your bed. Those things are scary because they’re dangerous—minimally, to our egos, or, maximally, to our chances of survival. Anxiety protects the organism. In the monster-under-the-bed cases, we can be helped with talk therapy or cognitive behavioral therapy, which teaches patients mechanisms for getting control over anxiety-producing trains of thought.

What appears to happen in the brains of people with acute anxiety disorder is what Peter Kramer, the author of “Listening to Prozac,” calls the “stuck switch” problem. The brain fails to shut down the release of stress hormones, and the body keeps pumping them out. The danger is that the overproduction will eventually damage the brain, so that, as Kramer puts it, “temporary injuries become permanent.” Solomon quotes Robert Post, formerly at the National Institute of Mental Health: “If you have too many episodes, it changes your biochemistry for the bad, possibly permanently. At that point, many therapists are still looking in completely the wrong direction. If the episode now occurs on automatic, what good is it to worry about the stressor that kicked off the original process? It’s just too late for that.” Stossel says that he worries about the harm to his brain. It seems a reasonable thing to worry about.

“To say that my anxiety is reducible to the ions in my amygdala”—the home of the fight-or-flight reflex—“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,” Stossel writes. He is being true to the sayings of Dr. W., and to the beliefs of many people who distrust the medicalization of mood disorders. Still, at the end of his book, Stossel makes a good case that his problem is, at bottom, genetic.

Louis Menand

I think that's a reasonable critique. The capitalism-versus-socialism framing can be useful for some questions, but it also compresses a much broader history of how humans have organized production, exchange, and governance.

For most of human history, people didn't live under anything we'd recognize as either "capitalism" or "socialism." They lived in societies characterized by combinations of:

• Kinship and reciprocal exchange.
• Gift economies.
• Common ownership of some resources alongside individual use of others.
• Tribute and taxation.
• Feudal obligations.
• Markets embedded within larger social and political institutions.

Historians and anthropologists such as Karl Polanyi, Marshall Sahlins, Elinor Ostrom, and David Graeber all, in different ways, argue that modern ideological categories often obscure this diversity.

Even the term "capitalism" itself is relatively recent. While historians debate exactly when capitalism begins, most would place its mature form within the last few centuries. Likewise, "socialism" emerges as a self-conscious political movement in the nineteenth century. Against the backdrop of perhaps 300,000 years of Homo sapiens, these are indeed recent developments.

Where the framing does make sense is when the question is narrowly about modern industrial economies. If you're asking:

• Should healthcare be publicly or privately financed?
• How should prices be determined?
• What role should the state play in industry?

then comparing capitalist and socialist traditions is natural because those are the ideologies that have dominated debates over industrial economies since the nineteenth century.

Where it becomes limiting is when it gets treated as if those are the only conceivable ways to organize economic life. That overlooks a vast range of arrangements, including:

• Ostrom's polycentric governance of commons.
• Cooperative enterprises.
• Mutual aid networks.
• Indigenous systems of land stewardship.
• Mixed economies (which virtually every country today has).
• Historical merchant republics, guild systems, and other hybrid institutions.

Language models often reproduce the capitalism/socialism dichotomy because it is extraordinarily common in textbooks, journalism, political commentary, and online debate. They're responding to the distribution of ideas in their training data, not necessarily making the philosophical claim that these are the only meaningful categories.

One subtle point is that economists often use "markets" and "capitalism" almost interchangeably in casual discussion, even though they are distinct concepts. Markets predate capitalism by millennia. Likewise, states, planning, and commons management predate socialism by millennia. Conflating these concepts can make debates seem more binary than they really are.

So I think there's a legitimate criticism here: many discussions jump too quickly from "how should scarce resources be allocated?" to "capitalism or socialism?" without considering the much larger design space of institutions that humans have developed across history.

'Scarcity has both biophysical and institutional dimensions. Physical limits exist, but institutions shape how scarcity is experienced and distributed. Ostrom's work demonstrates that communities can govern scarce commons without relying exclusively on markets or centralized planning, while Sahlins argued that scarcity itself depends partly on culturally defined wants. These perspectives suggest that the question is not simply whether capitalism or central planning is "correct," but which institutional arrangements best match particular resources and social contexts'.

Yes. In My Age of Anxiety and related interviews, Scott Stossel is unusually candid about the breadth of his anxiety. Some of these are clinically recognized phobias; others are persistent anxiety themes or obsessive worries rather than formal phobias.

Specific phobias he has explicitly described

• Claustrophobia — fear of enclosed spaces.
• Acrophobia — fear of heights.
• Asthenophobia — fear of fainting.
• Agoraphobic fears — especially being trapped or far from home where escape would be difficult.
• Bacillophobia (germ phobia) — fear of germs and contamination.
• Turophobia — fear of cheese (one of his most unusual and widely discussed phobias).
• Social anxiety / public speaking anxiety — fear of speaking before groups.
• Aerophobia — fear of flying.
• Emetophobia — fear of vomiting.
• Aeronausiphobia — fear of vomiting while flying, which combines two of his strongest fears.

Lifelong anxiety themes

He also describes chronic anxieties that don't fit neatly into a single phobia:

• Separation anxiety beginning in early childhood.
• Persistent worry that his parents had died or abandoned him.
• Health anxiety (about his own health).
• Anxiety about family members' health.
• Financial worries.
• Work and performance anxiety.
• Fear of aging.
• Fear of death.
• Generalized worry about everyday problems ("everything and nothing," as he puts it).

Physical manifestations

Stossel emphasizes that his anxiety is intensely physical as well as psychological. He reports episodes of:

• severe nausea
• shaking
• profuse sweating
• panic attacks
• shortness of breath
• difficulty swallowing
• difficulty walking
• dizziness and vertigo

He notes that these symptoms can themselves become the focus of obsessive fear, creating a self-reinforcing cycle.

Treatments he says he has tried

Over several decades, he reports trying:

• psychotherapy
• cognitive behavioral therapy (CBT)
• rational emotive therapy (RET)
• acceptance and commitment therapy (ACT)
• exposure therapies
• EMDR
• hypnosis
• meditation
• yoga
• acupuncture
• massage
• Stoic philosophy
• prayer
• multiple medications

His conclusion is not that any one treatment is a universal cure, but that anxiety is a complex interaction of genetics, temperament, biology, psychology, and environment, often requiring a combination of approaches.

One of the striking aspects of Stossel's memoir is that despite experiencing this extensive constellation of fears from early childhood, he maintained a successful career as a magazine editor, writer, husband, and father. His book is as much an exploration of how someone can function alongside severe anxiety as it is a catalog of the anxieties themselves.

Anxiety is "acedia" in its active, restless form or modern "Agoraphobia". Historically coined by early Christian desert monks to describe midday panic and the desperate urge to flee one's circumstances, these conditions share the same root. [1, 2, 3, 4]

The Parallel to "Noonday Demon"

• Acedia: Translated as the "Noonday Demon" by early theologians, it originally manifested not just as listlessness, but as an acute, restless anxiety. Monks reported an unreasonable confusion of mind, dread of the present, and the frantic desire to escape their daily routine. [1, 2, 3, 4]
• Andrew Solomon’s View: In The Noonday Demon, author Andrew Solomon notes that depression and anxiety frequently exist on a single genetic and psychological continuum. [1]

The Manifestation of Anxiety

While depression is characterized as an absence of vitality, its counterpart manifests as a "fight or flight" response—an intense terror without a specific cause: [1]

• Agoraphobia: Deeply rooted in ancient texts on the "midday devil," early desert monks reported dreading the heat of the sun and harboring an intense fear of the surrounding wilderness. In modern contexts, this fear of being trapped in uncontrollable or open spaces often plagues individuals with severe anxiety. [1, 2]
• Panic and Restlessness: The "Noonday Demon" is driven by a feeling of a day stretching on endlessly. In anxiety, this exact same mechanism appears as racing thoughts, fidgeting, and an overwhelming sense that life is happening elsewhere. [1, 2]

Stossel

“When I behold my possibilities,” Kierkegaard wrote, “I experience that dread which is the dizziness of freedom, and my choice is made in fear and trembling.” Many people try to flee anxiety by fleeing choice. This helps explain the perverse-seeming appeal of authoritarian societies—the certainties of a rigid, choiceless society can be very reassuring—and why times of upheaval so often produce extremist leaders and movements: Hitler in Weimar Germany, Father Coughlin in Depression-era America, or Jean-Marie Le Pen in France and Vladimir Putin in Russia. But running from anxiety, Kierkegaard believed, was a mistake because anxiety was a “school” that taught people to come to terms with the human condition.

Scott Stossel



More than a few people, some of whom think they know me quite well, have remarked that they are struck that I, who can seem so even-keeled and imperturbable, would choose to write a book about anxiety. I smile gently while churning inside and thinking about what I’ve learned is a signature characteristic of the phobic personality: “the need and ability”—as described in the self-help book Your Phobia—“to present a relatively placid, untroubled appearance to others, while suffering extreme distress on the inside.

Scott Stossel



Some social phobics find even positive attention to be aversive. Think of the young child who bursts into tears when guests sing “Happy Birthday” to her at a party—or of Elfriede Jelinek afraid to pick up her Nobel Prize. Social attention—even positive, supportive attention—activates the neurocircuitry of fear. This makes sense from an evolutionary perspective. Calling positive attention to yourself can incite jealousy or generate new rivalries.

Scott Stossel



Individuals who rate high on the so-called Anxiety Sensitivity Index, or ASI, have a high degree of what's known as interoceptive awareness, meaning they are highly attuned to the inner workings on their bodies, to the beepings and bleatings, the blips and burps, of their physiologies; they are more conscious of their heart rate, blood pressure, digestive burblings, and so forth than other people are.

Scott Stossel



The truth is that anxiety is at once a function of biology and philosophy, body and mind, instinct and reason, personality and culture. Even as anxiety is experienced at a spiritual and psychological level, it is scientifically measurable at the molecular level and the physiological level. It is produced by nature and it is produced by nurture. It’s a psychological phenomenon and a sociological phenomenon. 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). The origins of a temperament are many faceted; emotional dispositions that may seem to have a simple, single source—a bad gene, say, or a childhood trauma—may not.

Scott Stossel



And no Grand Inquisitor has in readiness such terrible tortures as has anxiety, and no spy knows how to attack more artfully the man he suspects, choosing the instant when he is weakest, nor knows how to lay traps where he will be caught and ensnared, as anxiety knows how, and no sharpwitted judge knows how to interrogate, to examine the accused as anxiety does, which never lets him escape, neither by diversion nor by noise, neither at work nor at play, neither by day nor by night.” —SØREN KIERKEGAARD, The Concept of Anxiety (1844)

Scott Stossel



For the social phobic, any kind of performance—musical, sporting, public speaking—can be terrifying because failure will reveal the weakness and inadequacy within. This in turn means constantly projecting an image that feels false—an image of confidence, competence, even perfection.

Scott Stossel



Evidence suggests that people with irritable bowels have bodies that are more physically reactive to stress. I recently came across an article in the medical journal Gut that explained the circular relationship between cognition (your conscious thought) and physiological correlates (what your body does in response to that thought): people who are less anxious tend to have minds that don’t overreact to stress and bodies that don’t overreact to stress when their minds experience it, while clinically anxious people tend to have sensitive minds in sensitive bodies—small amounts of stress set them to worrying, and small amounts of worrying set their bodies to malfunctioning. People with nervous stomachs are also more likely than people with settled stomachs to complain of headaches, palpitations, shortness of breath, and general fatigue. Some evidence suggests that people with irritable bowel syndrome have greater sensitivity to pain, are more likely to complain about minor ailments like colds, and are more likely to consider themselves sick than other people.

Scott Stossel

But various studies conducted since the early 1960s suggest that the James-Lange theory was not, after all, completely wrong. When researchers at Columbia gave study subjects an injection of adrenaline, the heart rate and breathing rate of all the subjects increased, and they all experienced an intensification of emotion—but the researchers could manipulate what emotion the subjects felt by changing the context. Those subjects given reason to feel positive emotions felt happy, while those given reason to feel negative emotions felt angry or anxious—and in every case they felt the respective emotion (whatever it happened to be) more powerfully than those subjects who had been given a placebo injection. The injection of adrenaline increased the intensity of emotion, but it did not determine what emotion that would be; the experimental context supplied that. This suggests that the autonomic systems of the body supply the mechanics of the emotion—but the mind’s interpretation of the outside environment supplies the valence.

Scott Stossel



Physical states create psychic ones and not vice-versa. The James-Lange theory was later undermined by research on patients with spinal cord injuries that prevented them from receiving any somatic information from their viscera—people who literally could not feel muscle tension or stomach discomfort; people who were, in effect, brains without bodies—yet who still reported experiencing the unpleasant psychological sensations of dread or anxiety. This suggested that the James-Lange theory was, if not wholly wrong, at least incomplete. If patients unable to receive information about the state of their bodies can still experience anxiety, then maybe anxiety is primarily a mental state, one that doesn’t require input from the rest of the body.

Scott Stossel

I found interesting historical evidence from World War II suggesting that neurotics living in London found their average level of anxiety actually declined during the Blitz - they had real things to worry about (bombs dropping on their heads) and also they felt relieved to see other people outwardly expressing the anxiety the neurotics felt all the time. Also, some sociologists have suggested that the Middle Ages were low in anxiety because a) they were so high in real danger (disease, murder, etc) and b) there was so little free choice, which actually reduces anxiety. Life in the Middle Ages was grim and awful- but may have been not particularly high in anxiety of the sort we denizens of the post-industrial capitalist age are.

Scott Stossel

I talk a lot in my about the relationship between conventional ideas about masculinity and courage and anxiety and cowardice and vulnerability. A striking quote posted on gun installations in Malta during World War II said something like: "If you are a man your self-respect will not allow you to admit to anxiety neurosis or to show fear." I think that captures the machismo-at-all costs view that prevails in society. (Also, British officers were allowed to respond to shows of cowardice in the ranks by shooting their own soldiers - or sterilizing them later on.) Things have improved since then, but one of my fears about, as it were, coming out about my own anxiety is that I will be perceived to be a lesser man. So far, I've been heartened by the response. People seem to think that being open about vulnerability is brave. Which is funny to me because I'm being told I'm brave for admitting I'm not brave, which is like a zen koan or something.

Scott Stossel

There's lot of research into the relationship between low self-esteem and both anxiety and depression. One school of clinical thought believes strongly that building up patients' sense of "self-efficacy" or "mastery" is key to reducing anxiety and depression.

Scott Stossel

There were a number of philosophers and other historical figures whose takes on anxiety I liked or found consoling, among them: Aristotle; Galen; Robert Burton; Pascal; Walker Percy. I was very drawn to the work on attachment theory by John Bowlby and Mary Ainsworth, and I spend a long chapter on them - but then I also spend a chapter on the work of Harvard psychologist Jerome Kagan and other scholars of genetics and temperament, whose work somewhat undermines, or at least complicates, the attachment theorists. Robert Sapolsky and Murray Stein and Stephen Suomi have all done fascinating research on social phobia and status in monkey tribes. Finally, I find myself awed by Darwin - not because of the genius of his insights into evolution (though that too) - but because of the epic nervous suffering he had to overcome. 

Scott Stossel

As the taxi to the interview site lurched its way through traffic in the August heat, I began to feel queasy. As I walked into the building where the interview was to take place, my nausea increased, which caused my anxiety to deepen, in the usual vicious cycle of heightening physiological and emotional distress.

Scott Stossel

I kept my medications out of sight. I generally did everything I could to project an aura of competence and confidence that was often at odds with the vulnerability, and sometimes the terror, that I felt.

Scott Stossel

I've finally settled on a pre-talk regimen that enables me to avoid the weeks of anticipatory misery that the approach of a public-speaking engagement would otherwise produce. Let’s say you’re sitting in an audience and I’m at the lectern. Here’s what I’ve likely done to prepare. Four hours or so ago, I took my first half milligram of Xanax. (I’ve learned that if I wait too long to take it, my fight-or-flight response kicks so far into overdrive that medication is not enough to yank it back.) Then, about an hour ago, I took my second half milligram of Xanax and perhaps 20 milligrams of Inderal. (I need the whole milligram of Xanax plus the Inderal, which is a blood-pressure medication, or beta-blocker, that dampens the response of the sympathetic nervous system, to keep my physiological responses to the anxious stimulus of standing in front of you—the sweating, trembling, nausea, burping, stomach cramps, and constriction in my throat and chest—from overwhelming me.) I likely washed those pills down with a shot of scotch or, more likely, vodka, the odor of which is less detectable on my breath. Even two Xanax and an Inderal are not enough to calm my racing thoughts and to keep my chest and throat from constricting to the point where I cannot speak; I need the alcohol to slow things down and to subdue the residual physiological eruptions that the drugs are inadequate to contain.

Scott Stossel

My method of dealing with my public-speaking anxiety is not healthy. It’s dangerous. But it works. Only when I am sedated to near-stupefaction by a combination of benzodiazepines and alcohol do I feel (relatively) confident in my ability to speak in public effectively and without torment. As long as I know that I’ll have access to my Xanax and liquor, I’ll suffer only moderate anxiety for days before a speech, rather than sleepless dread for months.

Scott Stossel

I wish I could say that my anxiety is a recent development, or that it is limited to public speaking. It’s not. On ordinary days, doing ordinary things—reading a book, lying in bed, talking on the phone, sitting in a meeting, playing tennis—I have thousands of times been stricken by a pervasive sense of existential dread and been beset by nausea, vertigo, shaking, and a panoply of other physical symptoms. In these instances, I have sometimes been convinced that death, or something somehow worse, was imminent.

Scott Stossel

Even when not actively afflicted by such acute episodes, I am buffeted by worry: about my health and my family members’ health; about finances; about work; about the rattle in my car and the dripping in my basement; about the encroachment of old age and the inevitability of death; about everything and nothing. Sometimes this worry gets transmuted into low-grade physical discomfort—stomachaches, headaches, dizziness, pains in my arms and legs—or a general malaise, as though I have mononucleosis or the flu. At various times, I have developed anxiety-induced difficulties breathing, swallowing, even walking; these difficulties then become obsessions, consuming all of my thinking.

Scott Stossel

During first grade, I spent nearly every afternoon for months in the school nurse’s office, sick with psychosomatic headaches, begging to go home; by third grade, stomachaches had replaced the headaches, but my daily trudge to the infirmary remained the same. 

Scott Stossel

“That’s what your thoughts are waiting for,” Nicholas says, describing how during a panic attack first your own thoughts and then your own body (and sometimes first your body and then your thoughts) betray you. Your thoughts “flood your head with news of the catastrophe unfolding in your body.”

Scott Stossel

For some—for me—the experience of certain kinds of anxiety has a disconcerting synesthetic quality. Rays of sunlight come through my eyes and get in my chest, and I feel like I’m gagging on them. For Nicholas, too, senses and even physical properties intersect with and become one another. Light takes on a solid, tactile quality (“black coils of sunlight heaped”)...And here he is after a panic attack: “I thought until there were no spaces between the thoughts, until each thought resembled the one before. I thought until my thoughts turned the color of darkness behind my eyelids, until they sounded like breathing.”

Nicholas provides a fine-grain anthropological analysis of status competition in high school, where “you have to be aware of your popularity,” he says. “It’s like your credit rating in adulthood.” But his anxiety makes achieving coolness a challenge—panic is the “opposite of cool.” Cool is “minimal consciousness” and “panic, on the other hand, is excess of consciousness. Your consciousness gets so strong it actually leaps out of your mind entirely. It starts vibrating your body. It shakes meat and bone.” Again, spot-on.

Scott Stossel