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