“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 of 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)
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 of 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 socially anxious, 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
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 book 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—stomach aches, 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, stomach-aches 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
Scott Stossel
On many occasions, my screaming bouts of night-time panic would awaken the whole family, and my father would lie patiently with me, trying to calm me down enough to sleep. But sometimes, exhausted and frustrated, he would lash out at me physically.
Scott Stossel
I don’t have to look far to find evidence of anxiety as a family trait. My great-grandfather Chester Hanford, for many years the dean of Harvard College, was in the late 1940s admitted to McLean Hospital, the famous mental institution in Belmont, Massachusetts, suffering from acute anxiety. The last 30 years of his life were often agonizing. Though medication and electroshock treatments would occasionally bring about remissions in his suffering, such respites were temporary, and in his darkest moments, in the 1960s, he was reduced to moaning in a fetal ball in his bedroom. Perhaps wearied by the responsibility of caring for him, his wife, my great-grandmother, a formidable and brilliant woman, died from an overdose of scotch and sleeping pills.
My mother, Chester’s granddaughter, is, like me, an inveterate worrier, and, though she enjoyed a productive career as an attorney, she suffers from some of the same phobias and neuroses that I do.
As a young woman, she suffered from panic attacks. At her most anxious (or so my father, her ex‑husband, says), her fears verged on paranoia: just after I was born, while suffering from postpartum depression, she became convinced that a serial killer in a yellow Volkswagen was watching our house. (Today, my mother and father, now divorced 15 years, disagree about the severity of the paranoia: my mother says it was negligible—and that, moreover, there really was a serial killer afoot at the time, a fact that research confirms.) My only sibling, a younger sister who is a successful cartoonist and editor, struggles with anxiety that is different from mine but nonetheless intense. She, too, has taken Celexa—and also Prozac and Wellbutrin and Klonopin and Nardil and Neurontin and BuSpar. None of them worked for her, and today she may be one of the few adult members of my mother’s side of the family not currently taking a psychiatric medication.
On the evidence of just my mother’s side of the family (and there is a separate complement of psychopathology coming down to me on the side of my father, a respected research physician who drank himself unconscious many nights throughout much of my later childhood), it is not outlandish to conclude that I possess...a genetic predisposition to anxiety and depression.
But these facts, by themselves, are not dispositive. In the 1920s, my great-grandparents had a young child who died of an infection. This was devastating to them. Perhaps this trauma, combined with the later trauma of having many of his students die in World War II, cracked something in my great-grandfather’s psyche. Perhaps my mother, in turn, was made anxious by the fussy ministrations of her worrywart mother; the psychological term for this is modeling. And perhaps I, observing my mother’s phobias, adopted them as my own.
Or maybe the generally unsettled nature of my childhood psychological environment—my mother’s constant anxious buzzing; my father’s alcoholic absence; their sometimes unhappy marriage, which would end in divorce—produced in me a comparably unsettled sensibility.
Scott Stossel
Medication has more reliably soothed my anxiety than other forms of therapy have. Yet the case for medication is not at all clear-cut.
Scott Stossel
Still, in most respects my parents maintained a safe, loving, and stable suburban home; many people grow up in circumstances far more traumatic than mine and don’t develop clinical anxiety. Ultimately, it’s impossible to disentangle nature and nurture—my anxiety is surely the result of both, and of the interaction between the two.
Scott Stossel
One young woman was referred to Alvarez after vomiting “day and night for a week.” When he learned that she had recently received an ominous letter from the Internal Revenue Service, he treated her by paying her back taxes—it turned out she owed only $3.85—and she was instantly cured. Another patient, whom Alvarez described as “a tense, high-pressure type of sales manager,” came to him because he loved poker but couldn’t play it: If he got a good hand, he would become “nauseated and chilly” and his face would turn red. Bluffing was impossible because any time he was dealt a full house or better, he would immediately have to get up and vomit.
Scott Stossel
Your mind sometimes instead produces distracting and defensive anxiety symptoms, transmuting psychic distress into panic attacks or free-floating general anxiety or developing phobias onto which you project your inner turmoil. Interestingly, a number of recent studies have found that at the moment an anxious patient begins to reckon consciously with a previously hidden psychic conflict, lifting it from the murk of the unconscious into the light of awareness, a slew of physiological measurements change markedly: blood pressure and heart rate drop, skin conductance decreases, levels of stress hormones in the blood decline. Chronic physical symptoms—backaches, stomachaches, headaches—often dissipate spontaneously as emotional troubles that had previously been “somaticized,” or converted into physical symptoms, get brought into conscious awareness.p
But in believing that anxiety disorders typically arise from failed efforts to resolve basic existential dilemmas, Dr. W. is, as we will see, running against the grain of modern psychopharmacology (which proffers the evidence of sixty years of drug studies to argue that anxiety and depression are based on “chemical imbalances”), neuroscience (whose emergence has demonstrated not only the brain activity associated with various emotional states but also, in some cases, the specific structural abnormalities associated with mental illness), and temperament studies and molecular genetics (which suggest, rather convincingly, a powerful role for heredity in the determination of one’s baseline level of anxiety and susceptibility to psychiatric illness).
Dr. W. doesn’t dispute the findings from any of those modes of inquiry. He believes medication can be an effective treatment for the symptoms of anxiety. But his view, based on thirty years of clinical work with hundreds of anxious patients, is that at the root of almost all clinical anxiety is some kind of existential crisis about what he calls the “ontological givens”—that we will grow old, that we will die, that we will lose people we love, that we will likely endure identity-shaking professional failures and personal humiliations, that we must struggle to find meaning and purpose in our lives, and that we must make trade-offs between personal freedom and emotional security and between our desires and the constraints of our relationships and our communities. In this view, our phobias of rats or snakes or cheese or honey (yes, honey; the actor Richard Burton could not bear to be in a room with honey, even if it was sealed in a jar, even if the jar was closed in a drawer) are displacements of our deeper existential concerns projected onto outward things.
Early in his career, Dr. W. treated a college sophomore who had trained his entire life to become a professional concert pianist. When the patient’s professors told him that he wasn’t talented enough to realize his dream, he was beset by terrible panic attacks. In Dr. W.’s view, the panic was a symptom produced by the patient’s inability to reckon with the underlying existential loss here: the end of his professional aspirations, the demise of his self-conception as a concert pianist. Treating the panic allowed the student to experience his despair at this loss—and then begin to construct a new identity. Another patient, a physician with a thriving medical practice, developed panic disorder when, right around the time his older son went off to college, he began getting injuries playing tennis, a sport at which he had formerly excelled. The panic, Dr. W. concluded, was precipitated by these dual losses (of his son’s childhood, of his own athletic vigor), which in combination aroused existential concerns about decline and death. By helping the physician come to terms with these losses, and to accept the “ontological” reality of his eventual decline and mortality, Dr. W. enabled him to shake free of the anxiety and depression.
In Dr. W.’s view, anxiety and panic symptoms serve as what he calls a “protective screen” (what Freud called a “neurotic defense”) against the searing pain associated with confronting loss or mortality or threats to one’s self-esteem (roughly what Freud called the ego). In some cases, the intense anxiety or panic symptoms patients experience are neurotic distractions from, or a way of coping with, negative self-images or feelings of inadequacy—what Dr. W. calls “self-wounds.”
I find Dr. W.’s existential-meaning-based interpretations of anxiety symptoms to be in some ways more interesting than the prevailing biomedical ones. But for a long time, I found the modern research literature on anxiety—which has much more to do with “neuronal firing rates in the amygdala and locus coeruleus” (as the neuroscientists put it) and with “boosting the serotonergic system” and “inhibiting the glutamate system” (as the psychopharmacologists put it) and with identifying the specific “single-nucleotide polymorphisms” on various genes that predict an anxious temperament (as the behavioral geneticists put it) than with existential issues—to be more scientific, and more convincing, than Dr. W.’s theory of anxiety. I still do. But less so than I did before.
Not long ago in my own therapy with Dr. W., we moved gingerly into “imaginal” exposure for my phobias.r Dr. W. and I established a hierarchy of frightening situations and then did a gentle “staged deconditioning,” in which I was supposed to picture certain distressing images while doing deep-breathing relaxation exercises, hoping to reduce the anxiety these images stimulated. Once I’d conjured an image and was trying to hold it in my mind without panicking, Dr. W. would ask me what I was feeling.
But in believing that anxiety disorders typically arise from failed efforts to resolve basic existential dilemmas, Dr. W. is, as we will see, running against the grain of modern psychopharmacology (which proffers the evidence of sixty years of drug studies to argue that anxiety and depression are based on “chemical imbalances”), neuroscience (whose emergence has demonstrated not only the brain activity associated with various emotional states but also, in some cases, the specific structural abnormalities associated with mental illness), and temperament studies and molecular genetics (which suggest, rather convincingly, a powerful role for heredity in the determination of one’s baseline level of anxiety and susceptibility to psychiatric illness).
Dr. W. doesn’t dispute the findings from any of those modes of inquiry. He believes medication can be an effective treatment for the symptoms of anxiety. But his view, based on thirty years of clinical work with hundreds of anxious patients, is that at the root of almost all clinical anxiety is some kind of existential crisis about what he calls the “ontological givens”—that we will grow old, that we will die, that we will lose people we love, that we will likely endure identity-shaking professional failures and personal humiliations, that we must struggle to find meaning and purpose in our lives, and that we must make trade-offs between personal freedom and emotional security and between our desires and the constraints of our relationships and our communities. In this view, our phobias of rats or snakes or cheese or honey (yes, honey; the actor Richard Burton could not bear to be in a room with honey, even if it was sealed in a jar, even if the jar was closed in a drawer) are displacements of our deeper existential concerns projected onto outward things.
Early in his career, Dr. W. treated a college sophomore who had trained his entire life to become a professional concert pianist. When the patient’s professors told him that he wasn’t talented enough to realize his dream, he was beset by terrible panic attacks. In Dr. W.’s view, the panic was a symptom produced by the patient’s inability to reckon with the underlying existential loss here: the end of his professional aspirations, the demise of his self-conception as a concert pianist. Treating the panic allowed the student to experience his despair at this loss—and then begin to construct a new identity. Another patient, a physician with a thriving medical practice, developed panic disorder when, right around the time his older son went off to college, he began getting injuries playing tennis, a sport at which he had formerly excelled. The panic, Dr. W. concluded, was precipitated by these dual losses (of his son’s childhood, of his own athletic vigor), which in combination aroused existential concerns about decline and death. By helping the physician come to terms with these losses, and to accept the “ontological” reality of his eventual decline and mortality, Dr. W. enabled him to shake free of the anxiety and depression.
In Dr. W.’s view, anxiety and panic symptoms serve as what he calls a “protective screen” (what Freud called a “neurotic defense”) against the searing pain associated with confronting loss or mortality or threats to one’s self-esteem (roughly what Freud called the ego). In some cases, the intense anxiety or panic symptoms patients experience are neurotic distractions from, or a way of coping with, negative self-images or feelings of inadequacy—what Dr. W. calls “self-wounds.”
I find Dr. W.’s existential-meaning-based interpretations of anxiety symptoms to be in some ways more interesting than the prevailing biomedical ones. But for a long time, I found the modern research literature on anxiety—which has much more to do with “neuronal firing rates in the amygdala and locus coeruleus” (as the neuroscientists put it) and with “boosting the serotonergic system” and “inhibiting the glutamate system” (as the psychopharmacologists put it) and with identifying the specific “single-nucleotide polymorphisms” on various genes that predict an anxious temperament (as the behavioral geneticists put it) than with existential issues—to be more scientific, and more convincing, than Dr. W.’s theory of anxiety. I still do. But less so than I did before.
Not long ago in my own therapy with Dr. W., we moved gingerly into “imaginal” exposure for my phobias.r Dr. W. and I established a hierarchy of frightening situations and then did a gentle “staged deconditioning,” in which I was supposed to picture certain distressing images while doing deep-breathing relaxation exercises, hoping to reduce the anxiety these images stimulated. Once I’d conjured an image and was trying to hold it in my mind without panicking, Dr. W. would ask me what I was feeling.
Scott Stossel
Life in a capitalist economy produces anxiety and uneasiness [and] can be psychologically corrosive. . .Perhaps the human organism is not equipped to live life as society has lately designed it—a harsh zero-sum competition where the only gains to be had are at the expense of someone else, where ‘neurotic competition’ has displaced solidarity and cooperation.
Scott Stossel
Some historians of science lump all the syndromes with this “matrix of distress symptoms”—psychological symptoms like worry and sadness and malaise, as well as physical ones like headaches, fatigue, back pain, sleeplessness, and stomach trouble—under the broad category of the “stress tradition.” “Stress” can refer to both psychological stresses and physical ones, in the form of the “stress” placed on the biological nervous system that doctors since the eighteenth century believed caused “nervous disease.”
Scott Stossel
Burton wrote that in the daytime melancholics “are affrighted still by some terrible object, and torn in pieces with suspicion, fear, sorrow, discontents, cares, shames, anguish, etc., as so many wild horses, that they cannot be quiet an hour, a minute of the time.”
Scott Stossel
Darwin observed that the equipment that produces panic anxiety in humans derives from the same evolutionary roots as the fight-or-flight reaction of a rat or the aversive maneuvering of a marine snail. Which means that anxiety, for all the philosophizing and psychologizing we’ve attached to it, may be an irreducibly biological phenomenon that is not so different in humans than in animals.
What, if anything, do we lose when our anxiety is reduced to the stuff of its physiological components—to deficiencies in serotonin and dopamine or to an excess of activity in the amygdala and basal ganglia? The theologian Paul Tillich, writing in 1944, suggested that Angst was the natural reaction of man to “fear of death, conscience, guilt, despair, daily life, etc.” For Tillich, the crucial question of life was: Are we safe in some deity’s care, or are we trudging along pointlessly toward death in a cold, mechanical, and indifferent universe? Is finding serenity mainly a matter of coming to terms with that question? Or is it, rather more mundanely, a matter of properly calibrating levels of serotonin in the synapses? Or are these somehow, after all, the same thing?
What, if anything, do we lose when our anxiety is reduced to the stuff of its physiological components—to deficiencies in serotonin and dopamine or to an excess of activity in the amygdala and basal ganglia? The theologian Paul Tillich, writing in 1944, suggested that Angst was the natural reaction of man to “fear of death, conscience, guilt, despair, daily life, etc.” For Tillich, the crucial question of life was: Are we safe in some deity’s care, or are we trudging along pointlessly toward death in a cold, mechanical, and indifferent universe? Is finding serenity mainly a matter of coming to terms with that question? Or is it, rather more mundanely, a matter of properly calibrating levels of serotonin in the synapses? Or are these somehow, after all, the same thing?
Scott Stossel
Anxiousness—a difficult disease. The patient thinks he has something like a thorn, something pricking him in his viscera, and nausea torments him.
—HIPPOCRATES, On Diseases (FOURTH CENTURY B.C.)
—HIPPOCRATES, On Diseases (FOURTH CENTURY B.C.)
Scott Stossel
Exposure therapy—in essence, exposure to whatever’s causing the pathological fear, whether that’s rats or snakes or airplanes or heights or throwing up—has for dozens of years been a standard treatment for phobias, and it is now an important component of cognitive-behavioral therapy. The logic of this approach—which has lately been undergirded by neuroscience research—is that extended exposure to the object of fear, under the guidance of a therapist, makes that object less frightening. Someone with fear of heights would, accompanied by a therapist, walk farther and farther out onto the balconies of higher and higher buildings. Someone with siderodromophobia (train phobia) would take a short subway ride, and then a longer one, and then a still-longer one, until the fear diminished and was gradually extinguished completely. A more aggressive form of exposure, known as flooding, calls for a more intense experience. To treat, say, airplane phobia using the standard exposure technique, a fearful flier might be started off with visits to the airport to watch airplanes take off and land until his anxiety level comes down. He would progress to actually walking onto an airplane and getting acclimated to being on it, allowing the intensity of physical responses and fearful emotions to crest and fall, and then advance to taking a short commercial flight in the company of a therapist. Ultimately, he would graduate to taking longer flights alone. Applying flooding to aerophobia might entail, instead, starting the patient out on a tiny twin-engine plane, flying him up into the sky, and subjecting him to stomach-churning aeronautical gymnastics. According to the theory, the patient’s anxiety will spike initially but will then subside as he learns quickly that he can survive both the flying and the experience of his own anxiety. Some therapists maintain relationships with local pilots so they can offer this sort of therapy. (Dr. M. offered it to me; I declined.)
Scott Stossel
The mind, as the neurophilosophers say, is fully embodied; it is, as Aristotle put it, “enmattered.” The bodily clichés of nervous excitement (“butterflies in the stomach”), anxious anticipation (“a loosening of the bowels,” “scared shitless”), or dread (felt “in the pit of the stomach”) are not in fact clichés or even metaphors but truisms—accurate descriptions of the physiological correlates of anxious emotion. Doctors and philosophers have observed for millennia the potency of what the medical journals call the brain-gut axis. “There may even be some connection between a phobia and a beef-steak, so intimately related are the stomach and the brain,” Wilfred Northfield wrote in 1934.
Nerve-disordered bellies are a bane of modern existence. According to a Harvard Medical School report, as many as 12 percent of all patient visits to primary care physicians in the United States are for irritable bowel syndrome, or IBS, a condition characterized by stomach pain and alternating bouts of constipation and diarrhea that most experts believe to be wholly or partly caused by stress or anxiety. First identified in 1830 by the British physician John Howship, IBS has since then been referred to as “spastic colon,” “spastic bowel,” “colitis,” and “functional bowel disease,” among other names. (Physicians in the Middle Ages and Renaissance referred to it as “windy melancholy” and “hypochondriache flatulence.”) Because no one has ever definitively identified an organic cause of IBS, most doctors attribute its appearance to stress, emotional conflict, or some other psychological source. In the absence of a clear malfunction in the nerves and muscles of the gut, doctors tend to assume a malfunction in the brain—perhaps a hypersensitized awareness of sensations in the intestine. In one well-known set of experiments, when balloons were inflated in the colons of both IBS patients and healthy control subjects, the IBS patients reported a much lower threshold for pain, suggesting that the viscera–brain connection may be more sensitive in patients with irritable bowels.
Nerve-disordered bellies are a bane of modern existence. According to a Harvard Medical School report, as many as 12 percent of all patient visits to primary care physicians in the United States are for irritable bowel syndrome, or IBS, a condition characterized by stomach pain and alternating bouts of constipation and diarrhea that most experts believe to be wholly or partly caused by stress or anxiety. First identified in 1830 by the British physician John Howship, IBS has since then been referred to as “spastic colon,” “spastic bowel,” “colitis,” and “functional bowel disease,” among other names. (Physicians in the Middle Ages and Renaissance referred to it as “windy melancholy” and “hypochondriache flatulence.”) Because no one has ever definitively identified an organic cause of IBS, most doctors attribute its appearance to stress, emotional conflict, or some other psychological source. In the absence of a clear malfunction in the nerves and muscles of the gut, doctors tend to assume a malfunction in the brain—perhaps a hypersensitized awareness of sensations in the intestine. In one well-known set of experiments, when balloons were inflated in the colons of both IBS patients and healthy control subjects, the IBS patients reported a much lower threshold for pain, suggesting that the viscera–brain connection may be more sensitive in patients with irritable bowels.
Scott Stossel
“Fear brings about diarrhea,” Aristotle wrote, “because the emotion causes an augmenting of heat in the belly.” Hippocrates attributed both bowel trouble and anxiety to a surplus of black bile. Galen, the ancient Roman physician, blamed yellow bile. “People attacked by fear experience no slight inflow of yellow bile into the stomach,” he observed, “which makes them feel a gnawing sensation, and they do not cease feeling both distress of mind and the gnawing until they have vomited up the bile.”
Scott Stossel
Psychologists have developed several standardized scales for measuring control-freakiness—there is, for instance, Rotter’s Locus of Control Scale and also the Health Locus of Control Scale. That anxiety and depression are bound up tightly not only with self-esteem issues but with control issues (anxiety disorder patients tend both to feel like they don’t have much control over their lives and to be afraid of losing control of their bodies or their minds) has been thoroughly established by generations of researchers.
Scott Stossel
As further evidence that a great deal of stomach trouble starts in the brain, not in the gut, no stomach medication has yet been proved consistently effective against the symptoms of irritable bowel syndrome—but substantial evidence suggests that certain antidepressant medications can be effective. (Before the 1960s, one of the most frequent prescriptions for IBS was a cocktail of morphine and barbiturates.) In a recent study, IBS patients injected with the SSRI antidepressant Celexa reported reduced “visceral hypersensitivity.”
Michael Gershon, a professor of pathology and cell biology at Columbia University, says that the reason antidepressants reduce IBS symptoms is not that they affect neurotransmitters in the brain but that they affect neurotransmitters in the stomach. Some 95 percent of the serotonin in our bodies can be found in our stomachs. (When serotonin was discovered in the 1930s, it was originally called enteramine because of its high concentration in the gut.) Gershon calls the stomach “the second brain” and observes that stomach trouble is as likely to beget anxiety as the other way around. “The brain in the bowel has got to work right or no one will have the luxury to think at all,” he says.
Michael Gershon, a professor of pathology and cell biology at Columbia University, says that the reason antidepressants reduce IBS symptoms is not that they affect neurotransmitters in the brain but that they affect neurotransmitters in the stomach. Some 95 percent of the serotonin in our bodies can be found in our stomachs. (When serotonin was discovered in the 1930s, it was originally called enteramine because of its high concentration in the gut.) Gershon calls the stomach “the second brain” and observes that stomach trouble is as likely to beget anxiety as the other way around. “The brain in the bowel has got to work right or no one will have the luxury to think at all,” he says.
Scott Stossel
Alvarez observed that the most common source of his patients’ chronic stomach discomfort was the “challenges of modern living”: “The stomach specialist has to be a psychiatrist of sorts,” he wrote.
Scott Stossel
As I approached the end of elementary school, my proliferating array of tics and phobias drove my parents to take me to the psychiatric hospital for the evaluation where it was determined I needed intensive psychotherapy. In seventh grade, I started at a new school. One Monday morning in October, I refused to go.
Scott Stossel
Stein’s research builds on the work of Robert Sapolsky, a neurobiologist at Stanford who has done fascinating research showing a direct correlation between a baboon’s status in his troop and the quantity of stress hormones in his blood. Baboon populations have strictly ordered male hierarchies: there is the alpha male, who is usually the biggest and strongest and has the most access to food and females and is deferred to by all the other male monkeys, then there is the second-highest-ranking monkey, who is deferred to by all the other monkeys except for the alpha male—and so on, all the way down to the lowest-ranking male at the bottom of the social ladder. If a fight breaks out between two baboons and the higher-ranking one wins, the social order is preserved; if the lower-ranking one wins, there is a re-sorting, with the victorious baboon moving up the social ladder. Through careful observation, Sapolsky’s team has been able to determine the social hierarchies of particular baboon populations. Using blood tests from these primates, Sapolsky has found that testosterone levels correlate directly with social standing: the higher ranking the baboon, the more testosterone he’ll have. Moreover, when a baboon rises in the social hierarchy, the amount of testosterone he produces increases; when a baboon declines in status, his testosterone levels fall. (The causation seems to work in both directions: testosterone produces dominance, and dominance produces testosterone.)
Scott Stossel
Low-status monkeys...tend to have notable irregularities in the processing of certain neurotransmitters. Studies have found that monkeys with enhanced serotonergic function (in essence, higher levels of serotonin in their brain synapses) tend to be more dominant, more friendly, and more likely than those with normal serotonin levels to bond with their peers. In contrast, monkeys with unusually low serotonin levels are more likely to display avoidant behavior: they keep to themselves and avoid social interactions.
Scott Stossel
My first glimpse of clinical depression came as I was sitting in class one Friday afternoon that year. I was experiencing my characteristic relief at the prospect of being sprung for the weekend when I had the thought But on Sunday night this starts all over again, and I was chilled by the infiniteness of my plight, by the notion that Sunday nights—and Monday mornings—eternally return, and that only death would put a stop to them, and that therefore there was nothing, ultimately, to look forward to that might help me transcend my dread about bad things to come.
Scott Stossel
The association of dopamine and serotonin with social phobia doesn’t prove that neurotransmitter deficits cause social anxiety—those irregularities could be the effects of social anxiety, the neurochemical “scars” that develop when a brain becomes overstressed from having to be so vigilant all the time, constantly scanning the environment for social threats. But emerging research suggests that the efficiency with which dopamine and serotonin get ferried across the synapses is genetically determined. Researchers have found that which variant of the serotonin transporter gene you have determines the density of serotonin receptors in your neurons—and that the relative density of your serotonin receptors helps determine where you fall on the spectrum between shy and extroverted.
Scott Stossel
David Sheehan, a psychiatrist who has studied and treated anxiety for forty years, tells a story that captures how awful the experience of panic can feel. In the 1980s, a World War II veteran, one of the first infantrymen to land at Normandy on D-day, came to see Sheehan, seeking therapy for panic attacks. Wasn’t the experience of storming the beach at Normandy, Sheehan asked him, bullets and blood and bodies flying and falling all around him—with the prospect of his own injury or death quite real, even likely—more frightening and miserable than enduring a panic attack at the dinner table, however ravaged he might feel by the neurotic circuitry of his own mind? Not at all, the man said. “The anxiety he felt landing on the beaches was mild compared to the sheer terror of one of his bad panic attacks,” Sheehan reports. “Given the choice between the two, he would gladly again volunteer to land in Normandy.”
Scott Stossel
The ancient Greeks believed that Pan, the god of nature, ruled over shepherds and their grazing flocks. Pan was not a noble god: he was short and ugly, ran on stubby goat like legs, and liked to take naps in caves or bushes by the side of the road. When awakened by passers-by, he would issue a bloodcurdling scream that made the hair of anyone who heard it stand on end. Pan’s scream, it was said, caused travellers to drop dead from fright. Pan induced terror even in his fellow gods. When the Titans assaulted Mount Olympus (as myth would have it), Pan assured their defeat by sowing fear and confusion in their ranks. The Greeks also credited Pan with their victory at the Battle of Marathon in 490 B.C., where he was said to have put anxiety in the hearts of the enemy Persians. The experience of sudden terror—especially in crowded places—became known as panic (from the Greek panikos, literally “of Pan”).
Scott Stossel
In the final chapter of The Problem of Anxiety, Freud gives brief attention to what he called the “biological factor,” by which he meant “the protracted helplessness and dependence of the young of the human species.”
Freud writes that “the human infant is sent into the world more unfinished than the young [of other species]”—meaning that humans emerge much more highly dependent on their fathers and mothers for their survival than do other animals.‖ The infant seems to be born with an instinctive sense that the mother can provide sustenance and succor, and learns very quickly that whereas the mother’s presence equals safety and comfort, her absence equals danger and discomfort. Observing this, Freud concluded that the earliest human anxiety, and thus to some degree the source of all subsequent ones, is a reaction to “the loss of the object”—the “object” being the mother. “This biological factor of helplessness thus brings into being the need to be loved which the human being is destined never to renounce,” Freud writes. The first anxiety is about the loss of a mother’s care; throughout the balance of life, “loss of love...becomes a new and far more abiding danger and occasion for anxiety.”
In the final pages of The Problem of Anxiety, Freud briefly develops the idea that phobic anxiety in adults is the residue of human evolutionary adaptations: phobias of such things as thunderstorms, animals, strangers, being alone, and being in the dark represent “the atrophied remnants of innate preparedness” against real dangers that existed in the state of nature. For early man and woman, being alone, or in the dark, or bitten by a snake or a lion—and, of course, the separation of an infant from his mother—were legitimate mortal threats. In all of this, Freud was anticipating the work of the biologists and neuroscientists who would study phobias in the decades ahead.
Freud writes that “the human infant is sent into the world more unfinished than the young [of other species]”—meaning that humans emerge much more highly dependent on their fathers and mothers for their survival than do other animals.‖ The infant seems to be born with an instinctive sense that the mother can provide sustenance and succor, and learns very quickly that whereas the mother’s presence equals safety and comfort, her absence equals danger and discomfort. Observing this, Freud concluded that the earliest human anxiety, and thus to some degree the source of all subsequent ones, is a reaction to “the loss of the object”—the “object” being the mother. “This biological factor of helplessness thus brings into being the need to be loved which the human being is destined never to renounce,” Freud writes. The first anxiety is about the loss of a mother’s care; throughout the balance of life, “loss of love...becomes a new and far more abiding danger and occasion for anxiety.”
In the final pages of The Problem of Anxiety, Freud briefly develops the idea that phobic anxiety in adults is the residue of human evolutionary adaptations: phobias of such things as thunderstorms, animals, strangers, being alone, and being in the dark represent “the atrophied remnants of innate preparedness” against real dangers that existed in the state of nature. For early man and woman, being alone, or in the dark, or bitten by a snake or a lion—and, of course, the separation of an infant from his mother—were legitimate mortal threats. In all of this, Freud was anticipating the work of the biologists and neuroscientists who would study phobias in the decades ahead.
Scott Stossel
When Ainsworth first arrived in Uganda, she agreed with both the Freudians and the behaviorists that the emotional attachment babies invested in their mothers was a secondary association with feeding: mothers provided breast milk, which provided comfort, so babies came to associate that feeling of comfort with the mother; there was nothing inherent in the maternal relationship itself, distinct from the provision of food, that was psychologically significant. But as Ainsworth totted up her meticulous observations, she changed her mind. The Freudians and behaviorists were wrong, she concluded, and Bowlby was right. When the babies began to crawl on their own and to explore the world around them, they would repeatedly return to their mothers—either physically or by exchanging a reassuring glance and a smile—and appeared always to remain conscious of exactly where their mothers were. Describing what she observed when the babies first began to crawl, Ainsworth wrote that the mothers seemed to provide the “secure base” from which these excursions can be made without anxiety. The secure base would go on to become a crucial element of Bowlby’s attachment theory.
Scott Stossel
The experiments yielded some interesting insights. In the first phase of the experiment, the babies would explore the room and look at the toys while checking in frequently with the mothers—suggesting that babies’ psychological need to operate from a “secure base” is indeed universal across cultures. But babies varied a lot in how distressed they would become when separated from their mothers: about half of them cried after their mothers left the room, and some babies became severely distressed and had a hard time recovering. When their mothers returned, the distressed babies would both cling to and hit them, displaying both anger and anxiety. Ainsworth labeled these insecure babies “ambivalent” in their attachment. Even more fascinating to Ainsworth than the ambivalent babies were those she would come to label “avoidant” in their attachment style: these babies seemed completely indifferent to their mothers’ departures and rarely got perturbed. Superficially, they seemed quite healthy and well adjusted. But Ainsworth would come to believe—and a lot of research would eventually be produced to support the idea—that the independence and equanimity these avoidant babies displayed were in fact the product of a defense mechanism, an emotional numbing designed to cope with maternal rejection.
Scott Stossel
Over the next few decades, the connection between attachment style and psychological health was repeatedly confirmed by a host of different measures.g A series of influential longitudinal studies begun by researchers at the University of Minnesota in the 1970s have found that securely attached children are happier, more enthusiastic, and more persistent and focused when working on experimental tasks than anxiously attached children are and that they have better impulse control. On almost every test the researchers devised, the securely attached children did better than the ambivalently attached ones: they had higher self-esteem, stronger “ego resiliency,” and less anxiety and were more independent; they were even better liked by their teachers. They also displayed greater empathy for others—probably because the insecurely attached children were too self-preoccupied to be much attuned to anyone else. The securely attached children just seemed to enjoy life more: none of the ambivalently attached children smiled, laughed, or expressed delight at the same level as the securely attached children. Many of the ambivalently attached children tended to fall apart when subjected to even minor stress.
Scott Stossel
A mother who, due to adverse experiences during childhood, grows up to be anxiously attached is prone to seek care from her own child and thereby lead the child to become anxious, guilty, and perhaps phobic.
—JOHN BOWLBY, A Secure Base
During the postwar decades, neurochemical research would demonstrate that when an infant or an adult is stressed, a cascading series of chemical reactions in the brain produces anxiety and emotional distress; returning to a secure base releases endogenous opiates that make the individual relax and feel safe. Why should this be so?
Back in the 1930s, John Bowlby, already absorbed in his studies of the mother-child bond, discovered the work of the early ethologists. Ethology, the scientific study of animal behavior, suggested that many of the attachment behaviors Bowlby had been observing in humans were universal to all mammals, and it supplied an evolutionary explanation for these behaviors.
—JOHN BOWLBY, A Secure Base
During the postwar decades, neurochemical research would demonstrate that when an infant or an adult is stressed, a cascading series of chemical reactions in the brain produces anxiety and emotional distress; returning to a secure base releases endogenous opiates that make the individual relax and feel safe. Why should this be so?
Back in the 1930s, John Bowlby, already absorbed in his studies of the mother-child bond, discovered the work of the early ethologists. Ethology, the scientific study of animal behavior, suggested that many of the attachment behaviors Bowlby had been observing in humans were universal to all mammals, and it supplied an evolutionary explanation for these behaviors.
Scott Stossel
Jeremy Coplan, the director of neuropsychopharmacology at State University of New York Downstate Medical Center, has been conducting VFD experiments for fifteen years. He says that these experiments appear to induce a “functional emotional separation” between mother and infant. The stressed mother becomes “psychologically unavailable” to her infant, in the way that a stressed-out human mother might become distracted and inattentive to her children.
The shifts in behavior might appear subtle—the stressed mothers still respond to the babies, they just tend to do so more slowly and less effectively than the unstressed mothers—but the effects can be potent. In a series of experiments, Coplan and his colleagues found that the children of the VFD mothers had higher levels of stress hormones in their blood than the children of the non-VFD mothers—an indication that the mother’s anxiety was being transmitted to the child. The remarkable thing was the duration of the correlation between the mother’s anxiety and the child’s stress hormones: when Coplan examined those original VFD children ten years after the first experiment, their levels of stress hormones were still higher than those of a control group. When they were injected with anxiety-provoking chemicals, their responses were hyperreactive compared with other monkeys’. Evidently, these VFD monkeys had become permanently more anxious: they were less social, more withdrawing, and more likely to display subordinate behavior; they also showed an elevated level of autonomic nervous system activity and a compromised immune response. Here was powerful physiological evidence of what Bowlby had argued half a century earlier: early child-rearing experiences—not just the obviously traumatic ones but subtle ones—have psychological and physical effects on the well-being of the child that persist even into adulthood. Coplan’s team concluded that even brief disruptions in the mother-child relationship can alter the development of neural systems “central to the expression of adult anxiety disorders.”l
The shifts in behavior might appear subtle—the stressed mothers still respond to the babies, they just tend to do so more slowly and less effectively than the unstressed mothers—but the effects can be potent. In a series of experiments, Coplan and his colleagues found that the children of the VFD mothers had higher levels of stress hormones in their blood than the children of the non-VFD mothers—an indication that the mother’s anxiety was being transmitted to the child. The remarkable thing was the duration of the correlation between the mother’s anxiety and the child’s stress hormones: when Coplan examined those original VFD children ten years after the first experiment, their levels of stress hormones were still higher than those of a control group. When they were injected with anxiety-provoking chemicals, their responses were hyperreactive compared with other monkeys’. Evidently, these VFD monkeys had become permanently more anxious: they were less social, more withdrawing, and more likely to display subordinate behavior; they also showed an elevated level of autonomic nervous system activity and a compromised immune response. Here was powerful physiological evidence of what Bowlby had argued half a century earlier: early child-rearing experiences—not just the obviously traumatic ones but subtle ones—have psychological and physical effects on the well-being of the child that persist even into adulthood. Coplan’s team concluded that even brief disruptions in the mother-child relationship can alter the development of neural systems “central to the expression of adult anxiety disorders.”l
Scott Stossel
Thomas Hobbes, the political philosopher, was born prematurely when his mother, terrified by a rumor that the Spanish armada was advancing toward English shores, went into labor in April 1588. “Myself and fear were born twins,” Hobbes wrote, and he attributed his own anxious temperament to the ambient turmoil of his gestation. Maybe Hobbes’s view that a powerful state needs to protect citizens from the violence and torment they naturally inflict on one another (life, he famously said, is nasty, brutish, and short) had its origins in utero, as his mother’s stress hormones washed through him.
Or do the roots of my anxiety lie even deeper and extend more broadly than the things I’ve experienced and the genes I’ve inherited—that is, in history and in culture? My father’s parents were Jews who emigrated from Weimar Germany. My father’s mother became a nastily anti-Semitic Jew—she renounced her Jewishness out of fear that she would someday be persecuted for it. My sister and I were raised in the Episcopal Church, our Jewish background hidden from us until I was in high school. My father, for his part, has had a lifelong fascination with World War II, and specifically with the Nazis; he watched the 1973–74 television series The World at War again and again. In my memory, that program, with its stentorian music accompanying the Nazi advance on Paris, is the running soundtrack to my early childhood.
Scott Stossel
One implication of the neurobiologist Robert Sapolsky’s work is that human social and political systems that are highly fluid and dynamic generate more anxiety than systems that are static. Sapolsky points out that “for 99 percent of human history” society was “most probably strikingly unhierarchical” and therefore probably less psychologically stressful than in the modern era. For hundreds of thousands of years, the standard form of human social organization was the hunter-gatherer tribe—and such tribes were, judging from what we know of the bands of hunter-gatherers that still exist today, “remarkably egalitarian.” Sapolsky goes so far as to say that the invention of agriculture, a relatively recent development in the scope of human history, “was one of the great stupid moves of all times” because it allowed for the stockpiling of food and, for the first time in history, “the stratification of society and the invention of classes.” Stratification created relative poverty, making possible the invidious comparison and producing the occasion for status anxiety.
Scott Stossel
The differences in how various cultures and eras have perceived and understood anxiety can tell us a lot about those cultures and eras. Why did the ancient Greeks of the Hippocratic school see anxiety mainly as a medical condition, while the Enlightenment philosophers saw it as an intellectual problem? Why did the early existentialists see anxiety as a spiritual condition, while Gilded Age doctors saw it as a specifically Anglo-Saxon stress response — a response that they believed spared Catholic societies — to the Industrial Revolution? Why did the early Freudians see anxiety as a psychological condition emanating from sexual inhibition, whereas our own age tends to see it, once again, as a medical and neurochemical condition, a problem of malfunctioning biomechanics? Do these shifting interpretations represent the forward march of progress and science? Or simply the changing, and often cyclical, ways in which cultures work?
Scott Stossel
Few people today would dispute that chronic stress is a hallmark of our times or that anxiety has become a kind of cultural condition of modernity. We live, as has been said many times since the dawn of the atomic era, in an age of anxiety — and that, cliché though it may be, seems only to have become more true in recent years.
Scott Stossel
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