My Age of Anxiety

“Fear sharpens the senses. Anxiety paralyses them” – Kurt Goldstein. 

Is anxiety a medical illness or a cognitive mis-wiring, a philosophical or a spiritual problem or a cultural condition explored by poets? 

Scott Stossel explores how anxiety is a function of all of these. It can be measured physiologically, it can be measured as a result of both nature and nurture, it is influenced by beliefs and by cultural context. Stossel himself is a man suffering from extreme anxiety. From a sweat-soaked appearance at his own wedding to a toilet mishap involving John F. Kennedy Jr. to his fear of flying, emetophobia (fear of vomiting), to endless treatments and therapy, his stories are horrifying, cringe-worthy, funny, brutally intimate and will make the average anxious individual feel capable of handling anything on earth in comparison. 

The research is divided into sections – a cultural history, the author’s own struggles with various treatments, performance anxiety, drugs, resilience and so on. The drawback here is that in order to re-introduce a particular point under a different context, Stossel repeats himself far too much. His emetophobia makes repeated appearances, each time given a fresh introduction which drags after a while. 

One of the most interesting aspects is how much he explores anxiety as a two-sided coin that both hampered and drove historical figures like Darwin and Freud to do their work and make discoveries. Their daunting list of phobias propelled their study of the human condition, often in an effort to seek respite from their suffering. Darwin wrote about his own inability to leave his house after his voyage on the Beagle. Even the thought of socialising might instigate a fit where he would vomit multiple times a day.

The author traces the history of writings about anxiety dating back centuries. In 1621, Robert Burton published “The Anatomy of Melancholy” by examining all the literature on the subject, from science to fiction. In 1844, Kierkegaard wrote that anxiety is what makes us human, using our imagination to worry about the future, the fears arising from within, and less so from an external threat.

 Stossel covers large swaths of territory in his fascinating journey through the evolution of anxiety as a recognised condition. The Diagnostic and Statistical Manual, which updates and revises lists of ailment and symptoms, can change the definition of a condition which then changes treatments. For example, PTSD, now a recognised disorder, wasn’t added to the DSM until 1980. In 1948, “psychoneurosis” in DMS-II turned into “neurosis” in 1968’s DSM-III. Treatments and pharmacology are developed in relatively ad hoc ways. Even Freud contradicted himself and changed the definitions, symptoms and causes of anxiety, at one point prescribing cocaine as a treatment. 

The role of the pharmaceutical industry in establishing a foothold in the population and the economy shows just how much the human condition can be either normalised or pathologized. “Every time new drug therapists come along, they raise the question of where the line between anxiety as psychiatric disorder and anxiety as a normal problem of living should get drawn” At various times, both heroin and opium were taken as legitimate medication for anxiety. 

Some of the most compelling information comes in the form of the debate of nature versus nurture. Stossel spends time with John Bowlby’s theory of attachment, which delineates individuals as being anxious, avoidant or secure types, predicted from behaviour in childhood and the relationship with the mother.

Some particularly cruel experiments have been done with animals to test this theory. Harry Harlow, present of the American Psychological Association, wanted to test whether babies became attached to their mothers only because they were fed by them. He separated eight rhesus monkeys from their mothers and put them with “surrogate mothers,” one made of wire mesh and one made of wood covered with cloth. In half, a rubber nipple offering milk was attached to the mesh figure, and in the other half it was attached to the wood figure. The assumption was that the monkeys would attach to whichever figure was offering milk. Instead, they all attached to the cloth figure, showing that they’d bond with a soft object even when the other object provided food. For the rest of their lives, the monkeys “exhibited abnormal social and sexual behaviour. They were abusive, even murderous, parents.” In stressful situations, they were much more anxiety and agitated. More experiments later showed that when infant monkeys were separated for even just a few days, they were more timid than their control counterparts.

Just as one is completely convinced that early upbringing almost certainly defines one’s anxious tendencies, Stossel turns this idea on its head via the literature showing the heritability of anxiety. Studies with twins show that when one has an anxiety disorder, the other has a higher likelihood of also developing it compared to the average general population.

Other studies with US Navy Seals show that those who handle the stress better have significantly higher levels of a particular brain chemical called neuropeptide Y (NPY). Some with very high levels seem immune to developing PTSD altogether. Yet, it’s possible that these high levels are awarded through training and developing resilience – something that can be improved.

Does this mean genetics point to those who would crack under pressure and those who can withstand almost anything? To counter this point, Stossel describes a Hall of Fame basketball player who epitomised success, yet vomited from anxiety before every game. “Intolerance of uncertainty appears to be the central process involved in high levels of worry” Yet, anxious personalities have also shown to be better workers because they are more conscientious.

The final section about resilience is sadly not explored as much as it could be. Robert Burton wrote in 1621, “for that which is but a flea-biting to one, causeth insufferable torment to another.” For all the literature, studies, developments and setbacks, this simple idea that anxiety is both a fundamental part of being human and the most personal experience still endures.