Vous êtes sur la page 1sur 20

Surviving Anxiety

I've tried therapy, drugs, and booze. Heres how I came to terms with the nation's most common mental illness.
SCOTT STOSSELDEC 22 2013, 9:25 PM ET
inShare More Email rint
!amie "hung
Ive #inally settled on a pre$tal% regimen that enables me to avoid the wee%s o# anticipatory misery that the approach o# a public$
spea%ing engagement would otherwise produce.
&ets say youre sitting in an audience and Im at the lectern. Heres what Ive li%ely done to prepare. 'our hours or so ago, I too% my
#irst hal# milligram o# (ana). *Ive learned that i# I wait too long to ta%e it, my #ight$or$#light response %ic%s so #ar into overdrive that
medication is not enough to yan% it bac%.+ ,hen, about an hour ago, I too% my second hal# milligram o# (ana) and perhaps
-. milligrams o# Inderal. *I need the whole milligram o# (ana) plus the Inderal, which is a blood$pressure medication, or beta$
bloc%er, that dampens the response o# the sympathetic nervous system, to %eep my physiological responses to the an)ious stimulus
o# standing in #ront o# you/the sweating, trembling, nausea, burping, stomach cramps, and constriction in my throat and chest/
#rom overwhelming me.+ I li%ely washed those pills down with a shot o# scotch or, more li%ely, vod%a, the odor o# which is less
detectable on my breath. Even two (ana) and an Inderal are not enough to calm my racing thoughts and to %eep my chest and
throat #rom constricting to the point where I cannot spea%0 I need the alcohol to slow things down and to subdue the residual
physiological eruptions that the drugs are inade1uate to contain. In #act, I probably dran% my second shot/yes, even though I might
be spea%ing to you at, say, 2 in the morning/between 34 and 5. minutes ago, assuming the pre$tal% proceedings allowed me a
moment to snea% away #or a 1ua##.
I# the usual pattern has held, as I stand up here tal%ing to you now, Ive got some (ana) in one poc%et *in case I #elt the need to pop
another one be#ore being introduced+ and a minibar$size bottle or two o# vod%a in the other. I have been %nown to ta%e a discreet
last$second swig while wal%ing onstage/because even as Im still e)periencing the an)iety that ma%es me want to drin% more, my
inhibition has been lowered, and my 6udgment impaired, by the li1uor and benzodiazepines Ive already consumed. I# Ive managed
to hit the sweet spot/that per#ect combination o# timing and dosage whereby the cognitive and psychomotor sedating e##ect o# the
drugs and alcohol balances out the physiological hyperarousal o# the an)iety/then Im probably doing o%ay up here7 nervous but not
miserable0 a little #uzzy but still able to spea% clearly0 the an)iogenic e##ects o# the situation *me, spea%ing in #ront o# people+
counteracted by the an)iolytic e##ects o# what Ive consumed. 8ut i# Ive overshot on the medication/too much (ana) or li1uor/I
2
may seem to be loopy or slurring or otherwise impaired. 9nd i# I didnt sel#$medicate enough: ;ell, then, either Im sweating
pro#usely, with my voice 1uavering wea%ly and my attention #olding in upon itsel#, or, more li%ely, I ran o##stage be#ore I got this #ar.
I mean that literally7 Ive #rozen, morti#yingly, onstage at public lectures and presentations be#ore, and on several occasions I have
been compelled to bolt #rom the stage.
<es, I %now. My method o# dealing with my public$spea%ing an)iety is not healthy. Its dangerous. 8ut it wor%s. =nly when I am
sedated to near$stupe#action by a combination o# benzodiazepines and alcohol do I #eel *relatively+ con#ident in my ability to spea%
in public e##ectively and without torment. 9s long as I %now that Ill have access to my (ana) and li1uor, Ill su##er only moderate
an)iety #or days be#ore a speech, rather than sleepless dread #or months.
I wish I could say that my an)iety is a recent development, or that it is limited to public spea%ing. Its not. My wedding was
accompanied by sweating so torrential that it soa%ed through my clothes and by sha%es so severe that I had to lean on my bride at
the altar, so as not to collapse. 9t the birth o# our #irst child, the nurses had to brie#ly stop ministering to my wi#e, who was in the
throes o# labor, to attend to me as I turned pale and %eeled over. Ive abandoned dates0 wal%ed out o# e)ams0 and had brea%downs
during 6ob interviews, plane #lights, train trips, and car rides, and simply wal%ing down the street. =n ordinary days, doing ordinary
things/reading a boo%, lying in bed, tal%ing on the phone, sitting in a meeting, playing tennis/I have thousands o# times been
stric%en by a pervasive sense o# e)istential dread and been beset by nausea, vertigo, sha%ing, and a panoply o# other physical
symptoms. In these instances, I have sometimes been convinced that death, or something somehow worse, was imminent.
Even when not actively a##licted by such acute episodes, I am bu##eted by worry7 about my health and my #amily members health0
about #inances0 about wor%0 about the rattle in my car and the dripping in my basement0 about the encroachment o# old age and the
inevitability o# death0 about everything and nothing. Sometimes this worry gets transmuted into low$grade physical discom#ort/
stomachaches, headaches, dizziness, pains in my arms and legs/or a general malaise, as though I have mononucleosis or the #lu. 9t
various times, I have developed an)iety$induced di##iculties breathing, swallowing, even wal%ing0 these di##iculties then become
obsessions, consuming all o# my thin%ing.
I also su##er #rom a number o# speci#ic #ears and phobias, in addition to my public$spea%ing phobia. ,o name a #ew7 enclosed spaces
*claustrophobia+0 heights *acrophobia+0 #ainting *asthenophobia+0 being trapped #ar #rom home *a species o# agoraphobia+0 germs
*bacillophobia+0 cheese *turophobia+0 #lying *aerophobia+0 vomiting *emetophobia+0 and, naturally, vomiting while #lying
*aeronausiphobia+.
9n)iety has a##licted me all my li#e. ;hen I was a child and my mother was attending law school at night, I spent evenings at home
with a babysitter, ab6ectly terri#ied that my parents had died in a car crash or had abandoned me *the clinical term #or this is
separation anxiety+0 by age > I had worn grooves in the carpet o# my bedroom with my relentless pacing, trying to will my parents to
come home. ?uring #irst grade, I spent nearly every a#ternoon #or months in the school nurses o##ice, sic% with psychosomatic
headaches, begging to go home0 by third grade, stomachaches had replaced the headaches, but my daily trudge to the in#irmary
remained the same. ?uring high school, I would purposely lose tennis and s1uash matches to escape the agony o# an)iety that
competitive situations would provo%e in me. =n the one/the only/date I had in high school, when the young lady leaned in #or a
%iss during a romantic moment *we were outside, gazing at constellations through her telescope+, I was overcome by an)iety and had
to pull away #or #ear that I would vomit. My embarrassment was such that I stopped returning her phone calls.
In short, I have, since the age o# about -, been a twitchy bundle o# phobias, #ears, and neuroses. 9nd I have, since the age o# 3., when
I was #irst ta%en to a mental hospital #or evaluation and then re#erred to a psychiatrist #or treatment, tried in various ways to
overcome my an)iety.
3
Heres what Ive tried7 individual psychotherapy *three decades o# it+, #amily therapy, group therapy, cognitive$behavioral therapy,
rational emotive behavior therapy, acceptance and commitment therapy, hypnosis, meditation, role$playing, interoceptive e)posure
therapy, in vivo e)posure therapy, sel#$help wor%boo%s, massage therapy, prayer, acupuncture, yoga, Stoic philosophy, and
audiotapes I ordered o## a late$night ,@ in#omercial.
9nd medication. &ots o# medication. ,horazine. Imipramine. ?esipramine. "hlorpheniramine. Aardil. 8uSpar. rozac. Bolo#t. a)il.
;ellbutrin. E##e)or. "ele)a. &e)apro. "ymbalta. &uvo). ,razodone. &evo)yl. Inderal. ,ran)ene. Sera). "entra). St. !ohns wort.
Bolpidem. @alium. &ibrium. 9tivan. (ana). Clonopin.
9lso7 beer, wine, gin, bourbon, vod%a, and scotch.
Heres whats wor%ed7 nothing.
9ctually, thats not entirely true. Some drugs have helped a little, #or #inite periods o# time. ,horazine *an antipsychotic that used to
be re#erred to as a Dma6or tran1uilizerE+ and imipramine *a tricyclic antidepressant+ combined to help %eep me out o# the psychiatric
hospital in the early 32F.s, when I was in middle school and ravaged by an)iety. ?esipramine, another tricyclic, got me through my
early -.s. a)il *a selective serotonin reupta%e inhibitor, or SSGI+ gave me about si) months o# signi#icantly reduced an)iety in my
late -.s be#ore the #ear bro%e through again. 9 double scotch plus a (ana) and a ?ramamine can sometimes, when administered
be#ore ta%eo##, ma%e #lying tolerable. 9nd two double scotches, when administered in 1uic% enough succession, can obscure
e)istential dread, ma%ing it seem #uzzier and #urther away.
8ut none o# these treatments has #undamentally reduced the underlying an)iety that seems hardwired into my body and woven into
my soul and that at times ma%es my li#e a misery.
My assortment o# neuroses may be idiosyncratic, but my general condition is hardly uni1ue. 9n)iety and its associated disorders
represent the most common #orm o# o##icially classi#ied mental illness in the Hnited States today, more common even than
depression and other mood disorders. 9ccording to the Aational Institute o# Mental Health, some I. million 9merican adults, about
one in si), are su##ering #rom some %ind o# an)iety disorder at any given time0 based on the most recent data #rom the ?epartment o#
Health and Human Services, their treatment accounts #or more than a 1uarter o# all spending on mental$health care. Gecent
epidemiological data suggest that one in #our o# us can e)pect to be stric%en by debilitating an)iety at some point in our li#etime. 9nd
it is debilitating7 studies have compared the psychic and physical impairment tied to living with an an)iety disorder with the
impairment tied to living with diabetes/both conditions are usually manageable, sometimes #atal, and always a pain to deal with. In
-.3-, 9mericans #illed nearly 4. million prescriptions #or 6ust one antian)iety drug7 alprazolam, the generic name #or (ana).
Ive abandoned dates; walked out of exams; and had breakdowns during job interviews, on flights, and simply walking down the
street.
9nd an)iety, o# course, e)tends #ar beyond the population o# the o##icially mentally ill. In a much$cited 32>J study, primary$care
physicians reported that an)iety was one o# the most #re1uent complaints driving patients to their o##ices/more #re1uent than the
common cold. 9lmost everyone alive has at some point e)perienced the torments o# an)iety/or o# #ear or o# stress or o# worry, which
are distinct but related phenomena. *eople who are unable to e)perience an)iety are, according to some theorists, more deeply
pathological/and more dangerous to society/than those who e)perience it acutely or irrationally0 theyre psychopaths.+
My li#e has, than%#ully, lac%ed great tragedy or melodrama. I havent served any 6ail time. I havent been to rehab. I havent assaulted
anyone or attempted suicide. I havent wo%en up na%ed in the middle o# a #ield, so6ourned in a crac% house, or been #ired #rom a 6ob
#or erratic behavior. 9s psychopathologies go, mine has been/so #ar, most o# the time, to outward appearances/1uiet. Gobert
4
?owney !r. will not be starring in the movie o# my li#e. I am, as they say in the clinical literature, Dhigh #unctioningE #or someone
with an an)iety disorder or other mental illness0 Im usually 1uite good at hiding it. ,his is a signature characteristic o# the phobic
personality7 Dthe need and the ability,E as described in the sel#$help boo% Your Phobia, Dto present a relatively placid, untroubled
appearance to others, while su##ering e)treme distress on the inside.E ,o some people, I may seem calm. 8ut i# you could peer
beneath the sur#ace, you would see that Im li%e a duc%/paddling, paddling, paddling.
Stigma still attaches to mental illness. 9n)iety is seen as wea%ness. In presenting my an)iety to the world by writing publicly about
it, Ive been told, I will be, in e##ect, Dcoming out.E ,he implication is that this will be liberating. ;ell see about that. 8ut my hope is
that readers who share this a##liction, to whatever e)tent, will #ind some value in this account/not a cure #or their an)iety, but
perhaps some sense o# the redemptive value o# an o#ten wretched condition, as well as evidence that they can cope and even thrive in
spite o# it. Most o# all, I hope they/and by DtheyE I mean Dmany o# youE/will #ind some solace in learning that they are not alone.
Stupe#ied by ,horazine and e)hausted by an a#ternoon o# an)iety$induced gastric distress, the author, age 3-, be#ore a classmate's
bar mitzvah in 32F- *"ourtesy o# the Stossel #amily+
I struggle with emetophobia, a pathological #ear o# vomiting, but its been a while since I last vomited. More than a while, actually7 as
I type this, its been, to be precise, 54 years, two months, #our days, -5 hours, and 5I minutes. Meaning that more than F5 percent o#
my days on Earth have transpired in the time since I last threw up, during the early evening o# March >, 32>>, when I was > years
old. I didnt vomit in the 32F.s. I didnt vomit in the 322.s. I havent vomited in the new millennium. 9nd needless to say, I hope to
ma%e it through the balance o# my li#e without having that strea% disrupted. *Aaturally, I was reluctant even to type this paragraph,
and particularly that last sentence, #or #ear o# 6in)ing mysel# or inviting cosmic rebu%e, and I am %noc%ing on wood and o##ering up
prayers to various gods and 'ates as I write this.+
;hat this means is that I have spent, by rough calculation, at least J. percent o# my wa%ing li#e thin%ing about and worrying about
something that I have spent zero percent o# the past three$plus decades doing. ,his is irrational.
5
9nd yet, an astonishing portion o# my li#e is built around trying to evade vomiting and preparing #or the eventuality that I might
throw up. Some o# my behavior is standard germophobic stu##7 avoiding hospitals and public restrooms, giving wide berth to sic%
people, obsessively washing my hands, paying care#ul attention to the provenance o# everything I eat.
8ut other behavior is more e)treme, given the statistical unli%elihood o# my vomiting at any given moment. I stash motion$sic%ness
bags, purloined #rom airplanes, all over my home and o##ice and car in case Im suddenly overta%en by the need to vomit. I carry
epto$8ismol and ?ramamine and other antiemetic medications with me at all times. &i%e a general monitoring the enemys
advance, I %eep a detailed mental map o# recorded incidences o# norovirus *the most common strain o# stomach virus+ and other
#orms o# gastroenteritis, using the Internet to trac% outbrea%s in the Hnited States and around the world. Such is the nature o# my
obsession that I can tell you at any given moment e)actly which nursing homes in Aew Bealand, cruise ships in the Mediterranean,
and elementary schools in @irginia are contending with outbrea%s. =nce, when I was lamenting to my #ather that there is no central
clearinghouse #or in#ormation about norovirus outbrea%s the way there is #or in#luenza, my wi#e inter6ected. D<es, there is,E she said.
;e loo%ed at her 1uizzically. D<ou,E she said.
n astonishing portion of my life is built around trying to evade vomiting and preparing for the eventuality that I might throw
up.
'or several years, in my mid$5.s, I wor%ed with a psychologist in 8oston, ?r. M., who had a practice at one o# the citys academic
medical centers. I had originally sought treatment #or a number o# phobias, but a#ter several months o# consultations, ?r. M.
determined/as several other therapists, be#ore and since, also have/that at the core o# my other #ears lay my #ear o# vomiting *#or
instance, Im a#raid o# airplanes partly because I might get airsic%+, so she proposed we concentrate on that.
DMa%es sense to me,E I concurred.
She e)plained that we would try to apply the principles o# whats %nown as e)posure therapy toward e)tinguishing my emetophobia.
D,heres only one way to do that properly,E she said. D<ou need to con#ront the phobia head$on, to e)pose yoursel# to that which you
#ear the most.E
!h"oh.
D;e have to ma%e you throw up.E
#o. #o way. bsolutely not.
She e)plained that a colleague had 6ust success#ully treated an emetophobe by giving her ipecac syrup, which induces vomiting. ,he
patient, a #emale e)ecutive who had #lown in #rom Aew <or% to be treated, had spent a wee% undergoing e)posure therapy. Each day
she would ta%e ipecac administered by a nurse, vomit, and then process the e)perience with the therapist/DdecatastrophizingE it, as
the cognitive$behavioral therapists say. ;hen she #lew bac% to Aew <or%, ?r. M. reported, she was cured o# her phobia.
I remained s%eptical. ?r. M. gave me an article #rom an academic 6ournal reporting on a clinical case o# emetophobia success#ully
treated with this %ind o# e)posure.
6
D,his is 6ust a single case,E I said. DIts #rom 32>2.E
D,here have been lots o# others,E she said, and reminded me again o# her colleagues patient.
DI cant do it.E
D<ou dont have to do anything you dont want to do,E ?r. M. said. DIll never #orce you to do anything. 8ut the only way to overcome
this phobia is to con#ront it. 9nd the only way to con#ront it is to throw up.E
;e had many versions o# this conversation over the course o# several months. I trusted ?r. M., who was %ind and smart. So one
autumn day I surprised her by saying I was open to thin%ing about the idea. Kently, reassuringly, she tal%ed me through how the
process would wor%. She and the sta## nurse would reserve a lab upstairs #or my privacy and would be with me the whole time. Id eat
something, ta%e the ipecac, and vomit in short order *and I would survive 6ust #ine, she said+. ,hen we would wor% on Dre#raming my
cognitionsE about throwing up. I would learn that it wasnt something to be terri#ied o#, and Id be liberated.
She too% me upstairs to meet the nurse. Aurse G. showed me the lab and told me that ta%ing ipecac was a standard #orm o# e)posure
therapy0 she said shed helped preside over a number o# e)posures #or now$erstwhile emetophobes. D!ust the other wee%, we had a
guy in here,E she said. DHe was very nervous, but it wor%ed out 6ust #ine.E
;e went bac% downstairs to ?r. M.s o##ice.
D=%ay,E I said. DIll do it. Maybe.E
=ver the ne)t #ew wee%s, wed %eep scheduling the e)posure/and then Id show up on the appointed day and demur, saying I
couldnt go through with it. I did this enough times that I shoc%ed ?r. M. when, on an unseasonably warm ,hursday in early
?ecember, I presented mysel# at her o##ice #or my regular appointment and said, D=%ay. Im ready.E
,he e)ercise was star$crossed #rom the beginning. Aurse G. was out o# ipecac, so she had to run to the pharmacy to get some more
while I waited #or an hour in ?r. M.s o##ice. ,hen it turned out that the upstairs lab was boo%ed, so the e)posure would have to ta%e
place in a small public restroom in the basement. I was constantly on the verge o# bac%ing out.
;hat #ollows is an edited e)cerpt drawn #rom the dispassionate$as$possible account I wrote up a#terward, on ?r. M.s
recommendation. *;riting an account o# a traumatic event is a commonly prescribed way o# trying to #orestall post$traumatic stress
disorder a#ter a harrowing e)perience.+ I# youre emetophobic yoursel#, or even 6ust a little s1ueamish, you might want to s%ip over it.
;e met up with Aurse G. in the basement restroom. 9#ter some discussion, I too% the ipecac.
Having passed the point o# no return, I #elt my an)iety surge considerably. I began to sha%e a little. Still, I was hope#ul that sic%ness
would stri%e 1uic%ly and be over #ast and that I would discover that the e)perience was not as bad as Id #eared.
?r. M. had attached a pulse$and$o)ygen$level monitor to my #inger. 9s we waited #or the nausea to hit, she as%ed me to state my
an)iety level on a scale o# one to 3.. D9bout a nine,E I said.
7
8y now I was starting to #eel a little nauseated. Suddenly I was struc% by heaving and I turned to the toilet. I retched twice/but
nothing was coming up. I %nelt on the #loor and waited, still hoping the event would come 1uic%ly and then be over. ,he monitor on
my #inger #elt li%e an encumbrance, so I too% it o##.
9#ter a time, I heaved again, my diaphragm convulsing. Aurse G. e)plained that dry heaving precedes the main event. I was now
desperate #or this to be over.
,he nausea began coming in intense waves, crashing over me and then receding. I %ept #eeling li%e I was going to vomit, but then I
would heave noisily and nothing would come up. Several times I could actually #eel my stomach convulse. 8ut I would heave and L
nothing would happen.
My sense o# time at this point gets blurry. ?uring each bout o# retching, I would begin perspiring pro#usely, and once the nausea
passed, I would be dripping with sweat. I #elt #aint, and I worried that I would pass out and vomit and aspirate and die. ;hen I
mentioned #eeling light$headed, Aurse G. said that my color loo%ed good. 8ut I thought she and ?r. M. seemed slightly alarmed.
,his increased my an)iety/because i# they were worried, then I should really be scared, I thought. *=n the other hand, at some level
I wanted to pass out, even i# that meant dying.+
9#ter about I. minutes and several more bouts o# retching, ?r. M. and Aurse G. suggested I ta%e more ipecac. 8ut I #eared a second
dose would sub6ect me to worse nausea #or a longer period o# time. I worried that I might 6ust %eep dry heaving #or hours or days. 9t
some point, I switched #rom hoping that I would vomit 1uic%ly and be done with the ordeal to thin%ing that maybe I could #ight the
ipecac and simply wait #or the nausea to wear o##. I was e)hausted, horribly nauseated, and utterly miserable. In between bouts o#
retching, I lay on the bathroom tiles, sha%ing.
9 long period passed. Aurse G. and ?r. M. %ept trying to convince me to ta%e more ipecac, but by now I 6ust wanted to avoid
vomiting. I hadnt retched #or a while, so I was surprised to be stric%en by another bout o# violent heaving. I could #eel my stomach
turning over, and I thought #or sure that this time something would happen. It didnt. I cho%ed down some secondary waves, and
then the nausea eased signi#icantly. ,his was the point when I began to #eel hope#ul that I would manage to escape the ordeal
without throwing up.
Aurse G. seemed angry. DMan, you have more control than anyone Ive ever seen,E she said. *9t one point, she as%ed peevishly
whether I was resisting because I wasnt prepared to terminate therapy yet. ?r. M. inter6ected that this was clearly not the case/Id
ta%en the ipecac, #or Kods sa%e.+ Eventually/several hours had now elapsed since Id ingested the ipecac/Aurse G. le#t, saying she
had never seen someone ta%e ipecac and not vomit. MIve since read that up to 34 percent o# people/a disproportionate number o#
them surely emetophobes/dont vomit #rom a single dose o# ipecac.N 9#ter some more time, and some more encouragement #rom
?r. M. to try to Dcomplete the e)posure,E we decided to Dend the attempt.E I still #elt nauseated, but less so than be#ore. ;e tal%ed
brie#ly in her o##ice, and then I le#t.
?riving home, I became e)tremely an)ious that I would vomit and crash. I waited at red lights in terror.
;hen I got home, I crawled into bed and slept #or several hours. I #elt better when I wo%e up0 the nausea was gone. 8ut that night I
had recurring nightmares o# retching in the bathroom in the basement o# the center.
,he ne)t morning I managed to get to wor% #or a meeting/but then panic surged and I had to go home. 'or the ne)t several days, I
was too an)ious to leave the house.
8
?r. M. called the day a#ter the ordeal to ma%e sure I was o%ay. She clearly #elt bad about having sub6ected me to such a horrible
e)perience. ,hough I was traumatized, her sense o# guilt was so palpable that I #elt sympathetic toward her. 9t the end o# the
account I composed at her re1uest, which was accurate as #ar as it went, I mas%ed the emotional reality o# what I thought *which was
that the e)posure had been an ab6ect disaster and that Aurse G. was a #atuous bitch+ with an antiseptic clinical tone. DKiven my
history, I was brave to ta%e the ipecac,E I wrote.
I wish that I had vomited 1uic%ly. 8ut the whole e)perience was traumatic, and my general an)iety levels/and my phobia o#
vomiting/are more intense than they were be#ore the e)posure. I also, however, recognize that, based on this e)perience in resisting
the e##ects o# the ipecac, my power to prevent mysel# #rom vomiting is 1uite strong.
Stronger, it seems, than ?r. M.s. She told me shed had to cancel all her a#ternoon appointments on the day o# the e)posure/
watching me gag and #ight with the ipecac had evidently made her so nauseated that she spent the a#ternoon at home, throwing up. I
con#ess I too% some perverse pleasure #rom the irony here/the ipecac I too% made someone else vomit/but mainly I #elt
traumatized. It seems Im not very good at getting over my phobias but 1uite good at ma%ing my therapists sic%.
I continued seeing ?r. M. #or a #ew more months/we DprocessedE the botched e)posure and then, both o# us wanting to #orget the
whole thing, turned #rom emetophobia to various other phobias and neuroses/but the sessions now had an elegiac, desultory #eel.
;e both %new it was over.
,he author with his grand#ather and great$grand#ather *at le#t, with cane+, who endured multiple hospitalizations and rounds o#
electroshoc% therapy #or an)iety between the 32I.s and 32J.s. *"ourtesy o# the Stossel #amily+
Is pathological an)iety a medical illness, as Hippocrates and 9ristotle and many modern psychopharmacologists would have it: =r is
it a philosophical problem, as lato and Spinoza and the cognitive$behavioral therapists would have it: Is it a psychological problem,
a product o# childhood trauma and se)ual inhibition, as 'reud and his acolytes once had it: =r is it a spiritual condition, as SOren
Cier%egaard and his e)istentialist descendants claimed: =r, #inally, is it/as ;. H. 9uden and ?avid Giesman and Erich 'romm and
9
9lbert "amus and scores o# modern commentators have declared/a cultural condition, a #unction o# the times we live in and the
structure o# our society:
,he truth is that an)iety is at once a #unction o# biology and philosophy, body and mind, instinct and reason, personality and culture.
Even as an)iety is e)perienced at a spiritual and psychological level, it is scienti#ically measurable at the molecular level and the
physiological level. It is produced by nature and it is produced by nurture. Its a psychological phenomenon and a sociological
phenomenon. In computer terms, its both a hardware problem *Im wired badly+ and a so#tware problem *I run #aulty logic
programs that ma%e me thin% an)ious thoughts+. ,he origins o# a temperament are many$#aceted0 emotional dispositions that seem
to have a simple, single source/a bad gene, say, or a childhood trauma/may not. 9#ter all, whos to say that Spinozas vaunted
e1uanimity, though ostensibly a result o# his philosophy o# applying logical reasoning to irrational #ear, wasnt in #act a product o# his
biology: Mightnt a genetically programmed low level o# autonomic arousal have produced his serene philosophy, rather than the
other way around:
I dont have to loo% #ar to #ind evidence o# an)iety as a #amily trait. My great$grand#ather "hester Han#ord, #or many years the dean
o# Harvard "ollege, was in the late 32I.s admitted to Mc&ean Hospital, the #amous mental institution in 8elmont, Massachusetts,
su##ering #rom acute an)iety. ,he last 5. years o# his li#e were o#ten agonizing. ,hough medication and electroshoc% treatments
would occasionally bring about remissions in his su##ering, such respites were temporary, and in his dar%est moments, in the 32J.s,
he was reduced to moaning in a #etal ball in his bedroom. erhaps wearied by the responsibility o# caring #or him, his wi#e, my great$
grandmother, a #ormidable and brilliant woman, died #rom an overdose o# scotch and sleeping pills in 32J2, a #ew months be#ore I
was born.
My mother, "hesters granddaughter, is, li%e me, an inveterate worrier, and, though she en6oyed a productive career as an attorney,
she su##ers #rom some o# the same phobias and neuroses that I do. She assiduously avoids heights *glass elevators, chairli#ts+, and
tends to avoid public spea%ing *when she has to tal% publicly, she ta%es beta$bloc%ers in advance+ and ris% ta%ing o# most %inds. &i%e
me, she is mortally terri#ied o# vomiting *and has not done so since 32>I+. 9s a young woman, she su##ered #rom panic attac%s. 9t her
most an)ious *or so my #ather, her e)$husband, says+, her #ears verged on paranoia7 6ust a#ter I was born, while su##ering #rom
postpartum depression, she became convinced that a serial %iller in a yellow @ol%swagen was watching our house. *,oday, my
mother and #ather, now divorced 34 years, disagree about the severity o# the paranoia7 my mother says it was negligible/and that,
moreover, there really was a serial %iller a#oot at the time, a #act that research con#irms.+ My only sibling, a younger sister who is a
success#ul cartoonist and editor, struggles with an)iety that is di##erent #rom mine but nonetheless intense. She, too, has ta%en
"ele)a/and also rozac and ;ellbutrin and Clonopin and Aardil and Aeurontin and 8uSpar. Aone o# them wor%ed #or her, and
today she may be one o# the #ew adult members o# my mothers side o# the #amily not currently ta%ing a psychiatric medication.
=n the evidence o# 6ust my mothers side o# the #amily *and there is a separate complement o# psychopathology coming down to me
on the side o# my #ather, a respected research physician who dran% himsel# unconscious many nights throughout much o# my later
childhood+, it is not outlandish to conclude that I possess what Sigmund 'reud called Dthe hereditary taint,E a genetic predisposition
to an)iety and depression.
8ut these #acts, by themselves, are not dispositive. In the 32-.s, my great$grandparents had a young child who died o# an in#ection.
,his was devastating to them. erhaps this trauma, combined with the later trauma o# having many o# his students die in ;orld
;ar II, crac%ed something in my great$grand#athers psyche. erhaps my mother, in turn, was made an)ious by the #ussy
ministrations o# her worrywart mother0 the psychological term #or this is modeling. 9nd perhaps I, observing my mothers phobias,
adopted them as my own.
10
=r maybe the generally unsettled nature o# my childhood psychological environment/my mothers constant an)ious buzzing0 my
#athers alcoholic absence0 their sometimes unhappy marriage, which would end in divorce/produced in me a comparably unsettled
sensibility. 8oth my mother and #ather were well intentioned and loving, but between them, they combined overprotection and
anger in a way that may have been particularly to)ic #or a child with an innately nervous temperament. =n many occasions, my
screaming bouts o# nighttime panic would awa%en the whole #amily, and my #ather would lie patiently with me, trying to calm me
down enough to sleep. 8ut sometimes, e)hausted and #rustrated, he would lash out at me physically. My mother dressed me until I
was 2 or 3. years old0 a#ter that, she pic%ed out my clothes #or me every night until I was about 34. She ran my baths until I was in
high school. 9ny time my sister and I were home while my parents were at wor%, we had the company o# a babysitter. 8y the time I
was a young teenager, this was getting a bit weird/as I realized the day I discovered, to our mutual discom#ort, that the babysitter
was my age *35+. My mother did all o# this out o# genuine love and an)ious concern. 9nd I welcomed the e)cess o# solicitude7 it %ept
me swaddled in a com#orting dependency. 8ut our relationship helped deprive me o# autonomy and a sense o# sel#$e##icacy.
$edi%ation has more reliably soothed my anxiety than other forms of therapy have. Yet the %ase for medi%ation is not at all %lear"
%ut.
Still, in most respects my parents maintained a sa#e, loving, and stable suburban home0 many people grow up in circumstances #ar
more traumatic than mine and dont develop clinical an)iety. Hltimately, its impossible to disentangle nature and nurture/my
an)iety is surely the result o# both, and o# the interaction between the two. 'or instance, its possible that my mothers an)iety while
pregnant with me/having endured two miscarriages #ollowed by di##iculty getting pregnant again, she says her already high level o#
worry was in#lamed by the #ear that she wouldnt carry me to term/produced such hormonal Sturm und ?rang in the womb that I
was doomed to be born nervous. Gesearch suggests that mothers who su##er stress while pregnant are more li%ely to produce an)ious
children. ,homas Hobbes, the political philosopher, was born prematurely when his mother, terri#ied by a rumor that the Spanish
armada was advancing toward English shores, went into labor in 9pril 34FF. DMysel# and #ear were born twins,E Hobbes wrote, and
he attributed his own an)ious temperament to the ambient turmoil o# his gestation. Maybe Hobbess view that a power#ul state
needs to protect citizens #rom the violence and torment they naturally in#lict on one another *li#e, he #amously said, is nasty, brutish,
and short+ had its origins in utero, as his mothers stress hormones washed through him.
=r do the roots o# my an)iety lie even deeper and e)tend more broadly than the things Ive e)perienced and the genes Ive inherited
/that is, in history and in culture: My #athers parents were !ews who emigrated #rom ;eimar Kermany. My #athers mother
became a nastily anti$Semitic !ew/she renounced her !ewishness out o# #ear that she would someday be persecuted #or it. My sister
and I were raised in the Episcopal "hurch, our !ewish bac%ground hidden #rom us until I was in high school. My #ather, #or his part,
has had a li#elong #ascination with ;orld ;ar II, and speci#ically with the Aazis0 he watched the 32>5P>I television series &he
'orld at 'ar again and again. In my memory, that program, with its stentorian music accompanying the Aazi advance on aris, is
the running soundtrac% to my early childhood. !ews, o# course, have millennia o# e)perience in having reason to be scared/which
perhaps e)plains why some studies have suggested that !ewish men are more li%ely to su##er #rom neuroses than are men in other
groups.
My mothers cultural heritage, on the other hand, is heavily ;9S0 she is a proud $ayflower descendant who until recently
subscribed to the notion that there is no emotion and no #amily issue that should not be suppressed.
,hus, me7 a mi)ture o# !ewish and ;9S pathology/a neurotic and histrionic !ew suppressed inside a neurotic and repressed
;9S. Ao wonder Im an)ious7 Im li%e ;oody 9llen trapped inside !ohn "alvin.
11
9n)ious on
vacation7 the author, age 3., in 8ermuda *"ourtesy o# the Stossel #amily+
Everyone %nows that an)iety can cause gastrointestinal distress. *My #riend 9nne says that the most e##ective weight$loss program
she ever tried was the Stress#ul$?ivorce ?iet.+ 8ut medical researchers have charted the connections in precise and systematic detail7
as ones mental state changes, #or instance, so does blood #low to and #rom the stomach. ,he gastrointestinal system is a concrete
and direct register o# ones psychology. In their 32I5 landmar% o# psychosomatic research, (uman )astri% *un%tion, the physicians
Stewart ;ol# and Harold ;ol## concluded that there was a strong inverse correlation between what they called Demotional securityE
and stomach discom#ort.
,hats certainly true in my case. 8eing an)ious ma%es my stomach hurt and my bowels loosen. My stomach hurting and my bowels
loosening ma%es me more an)ious, which ma%es my stomach hurt more and my bowels even looser, and so nearly every trip o# any
signi#icant distance #rom home ends up the same way7 with me scurrying #rantically #rom restroom to restroom on a %ind o# grand
tour o# the local latrines. 'or instance, I dont have terribly vivid recollections o# the @atican or the "olosseum or the Italian rail
system. I do, however, have detailed memories o# the public restrooms in the @atican and at the "olosseum and in various Italian
train stations in the winter o# -..-. =ne day, I visited the ,revi 'ountain/or, rather, my wi#e and her #amily visited the ,revi
'ountain. I visited the restroom o# a nearby gelateria, where a series o# impatient Italians banged on the door while I bivouac%ed
there. ,he ne)t day, when the #amily drove to ompeii, I gave up and stayed in bed, a reassuringly short distance #rom the bathroom.
;hen your stomach governs your e)istence, its hard not to be preoccupied with it. 9 #ew searing e)periences/soiling yoursel# on an
airplane, say, or on a date *and yes, I have done both+/will #ocus you passionately on your gastrointestinal tract. <ou need to devote
e##ort to planning around it/because it will not plan around you.
"ase in point7 In the summer o# 322>, while researching my #irst boo%, a biography o# Sargent Shriver/who #ounded the eace "orps
#or his brother$in$law !ohn '. Cennedy/I spent part o# the summer living with the e)tended Cennedy #amily on "ape "od. =ne
wee%end, then$resident 8ill "linton, who was vacationing on Marthas @ineyard, went sailing with ,ed Cennedy, and I suspected
12
that Hyannis ort, Massachusetts, where the Cennedys have their vacation homes, would be crawling with Secret Service agents.
;ith some time to %ill be#ore dinner, I decided to wal% around town to ta%e in the scene.
8ad idea. 9s is so o#ten the case #or people with unruly, nervous bellies, it was at precisely the moment I passed beyond Easily$
9ccessible$8athroom Gange that my plumbing came unglued. ;hile sprinting bac% to the house where I was staying, I was several
times convinced I would not ma%e it and/teeth gritted, sweating voluminously/was reduced to evaluating various bushes and
storage sheds along the way #or their potential as ersatz outhouses. Imagining what might ensue i# a Secret Service agent were to
happen upon me crouched in the shrubbery lent a %ind o# panic%ed, otherworldly strength to my e##orts at sel#$possession.
9s I approached the entrance, I was simultaneously reviewing the #loor plan in my head *'hi%h of the many bathrooms in the
mansion is %losest to the front door++ and praying that I wouldnt be #atally waylaid by a stray Cennedy or celebrity *as I recall,
9rnold Schwarzenegger, &iza Minnelli, and the secretary o# the Aavy, among others, were visiting that wee%end+.
'ortunately, I made it into the house unaccosted. ,hen a 1uic% calculation7 ,an I make it all the way upstairs and down the hall to
my suite in time+ -r should I du%k into the bathroom in the front hall+ Hearing #ootsteps above and #earing a protracted encounter,
I opted #or the latter and slipped into the bathroom, which was separated #rom the #ront hall by an anteroom and two separate doors.
I scampered through the anteroom and #lung mysel# onto the toilet.
My relie# was e)travagant and almost metaphysical.
8ut then I #lushed and L something happened. My #eet were getting wet. I loo%ed down and saw to my horror that water was #lowing
out #rom the base o# the toilet. Something seemed to have e)ploded. ,he #loor/along with my shoes and pants/was covered in
sewage. ,he water level was rising.
"ould the #looding be stopped: ,urning around, I removed the porcelain top o# the toilet tan%, scattering the #lowers and potpourri
that sat atop it, and #rantically began #iddling with its innards. I tried things blindly, raising this and lowering that, 6iggling this and
wiggling that, #ishing around in the water #or something that might stem the swelling tide.
Somehow, whether o# its own accord or as a result o# my haphazard #iddling, the #looding slowed and then stopped. I surveyed the
scene. My clothes were drenched and soiled. So was the bathroom rug. ;ithout thin%ing, I slipped o## my pants and bo)er shorts,
wrapped them in the waterlogged rug, and 6ammed the whole mess into the wastebas%et, which I stashed in the cupboard under the
sin%. (ave to deal with this later, I thought to mysel#.
It was at this unpropitious moment that the dinner bell rang, signaling that it was time to muster #or coc%tails in the living room.
;hich was right across the hall #rom the bathroom.
;here I was standing an%le$deep in sewage.
I pulled some towels o## the wall and dropped them on the ground to start sopping up some o# the toilet water. I got down on my
hands and %nees and, unraveling the whole roll o# toilet paper, began dabbing #renziedly at the water around me. It was li%e trying to
dry a la%e with a %itchen sponge.
13
;hat I was #eeling at that point was not, strictly spea%ing, an)iety0 rather, it was a resigned sense that the 6ig was up, that my
humiliation would be complete and total. Id soiled mysel#, destroyed the estates septic system, and might soon be standing hal#
na%ed be#ore Kod %nows how many members o# the political and Hollywood elite.
In the distance, voices were moving closer. It occurred to me that I had two choices. I could hun%er down in the bathroom, hiding
and waiting out the coc%tail party and dinner/at the ris% o# having to #end o## anyone who might start %noc%ing on the door/and
use the time to try to clean up the wrec%age be#ore slipping up to my bedroom a#ter everyone had gone to bed. =r I could try to ma%e
a brea% #or it.
I too% all the soiled towels and toilet paper and shoved them into the cupboard, then set about preparing my escape. I retrieved the
least soiled towel *which was nonetheless dirty and sodden+ and wrapped it gingerly around my waist. I crept to the door and
listened #or voices and #ootsteps, trying to gauge distance and speed o# approach. Cnowing I had scarcely any time be#ore everyone
converged on the center o# the house, I slipped out o# the bathroom and through the anteroom, sprint$wal%ed across the hallway,
and darted up the stairs. I hit the landing, made a hairpin turn, and headed up the ne)t #light to the second #loor/where I nearly ran
headlong into !ohn '. Cennedy !r. and another man.
DHi, Scott,E Cennedy said. *Id 6ust met him #or the #irst time the day be#ore. DIm !ohn Cennedy,E he had said when he e)tended his
hand in introduction. I know, I had thought as I e)tended mine, thin%ing it #unny that he had to pretend courteously that people
might not %now his name, despite the ubi1uity o# his #ace on the cover o# chec%out$counter magazines.+
DHh, hi,E I said, rac%ing my brain #or a plausible e)planation #or why I might be running through the house at coc%tail hour with no
pants on, drenched in sweat, swaddled in a soiled and ree%ing towel. 8ut he and his #riend appeared utterly un#azed/as though hal#$
na%ed houseguests covered in their own e)crement were common here/and wal%ed past me down the stairs.
I scrambled down the hallway to my room, where I showered vigorously, changed, and tried to compose mysel# as best I could/
which was not easy because I was still sweating terribly, right through my blazer, the result o# an)iety, e)ertion, and summer
humidity.
.(i, /%ott,0 1ennedy said. (e appeared unfa2ed3as though half"naked houseguests %overed in their own ex%rement were %ommon
here.
I# someone had snapped a photo o# the scene at coc%tails that evening, heres what it would show7 various celebrities and politicians
and priests all glowing with grace and easy bonhomie as they mingle e##ortlessly on the veranda overloo%ing the 9tlantic/while, 6ust
o## to the side, a sweaty young writer stands aw%wardly gulping gin and tonics and thin%ing about how #ar he is #rom #itting in with
this illustrious crowd and about how not only is he not rich or #amous or accomplished or particularly good$loo%ing, but he cannot
even control his own bowels and there#ore is better suited #or the company o# animals or in#ants than o# adults, let alone adults as
luminous and signi#icant as these.
,he sweaty young writer is also worrying about what will happen when someone tries to use the hallway bathroom.
&ate that night, a#ter everyone had gone o## to bed, I snea%ed bac% down to the bathroom with a trash bag and paper towels and
cleaning detergent Id pil#ered #rom the pantry. I couldnt tell whether anyone had been there since I le#t, but I tried not to worry
about that and concentrated on stu##ing the soiled rug and towels and clothes and toilet paper Id stashed under the sin% into the
trash bag. ,hen I used the paper towels to scrub the #loor, and I put those into the trash bag as well.
14
=utside the %itchen, between the main house and an outbuilding, was a ?umpster. My plan was to dispose o# everything there.
Aaturally, I was terri#ied o# getting caught. ;hat, e)actly, would a houseguest be doing disposing o# a large trash bag outside in the
middle o# the night: *I worried that there might still be Secret Service a#oot, who might shoot me be#ore allowing me to plant what
loo%ed li%e a bomb or a body in the ?umpster.+ 8ut what choice did I have: I slun% through the house and out to the ?umpster,
where I deposited the trash bag. ,hen I went bac% upstairs to bed.
Ao one ever said anything to me about the hallway bathroom or about the missing rug and towels. 8ut #or the rest o# the wee%end,
and on my subse1uent visits there, I was convinced that various household$sta## members were glaring at me and whispering.
D,hats him,E I imagined they were saying in disgust. D,he one who bro%e the toilet and ruined our towels. ,he one who cant control
his own bodily #unctions.E
=n 9pril 35, -..I, at - ocloc% in the a#ternoon, I, then 5I years old and wor%ing as a senior editor at &he tlanti% and dreading the
publication o# my Sargent Shriver biography, presented mysel# at the nationally renowned "enter #or 9n)iety and Gelated ?isorders
at 8oston Hniversity. 9#ter meeting #or several hours with a psychologist and two graduate students and #illing out dozens o# pages
o# 1uestionnaires, I was given a principal diagnosis o# Dpanic disorder with agoraphobiaE and additional diagnoses o# Dspeci#ic
phobiaE and Dsocial phobia.E ,he clinicians also noted in their report that my 1uestionnaire answers indicated Dmild levels o#
depression,E Dstrong levels o# an)iety,E and Dstrong levels o# worry.E
;hy so many di##erent diagnoses: 9nd why were they di##erent #rom the diagnoses o# my youth *Dphobic neurosis,E Doveran)ious
reaction disorder o# childhoodE+: Had the nature o# my an)iety changed so much: How can we ma%e scienti#ic or therapeutic
progress i# we cant agree on what an)iety is:
Even Sigmund 'reud, the inventor, more or less, o# the modern idea o# neurosis/a man #or whom an)iety was a %ey, i# not the %ey,
#oundational concept o# his theory o# psychopathology/contradicted himsel# over the course o# his career. Early on, he said that
an)iety arose #rom une)pressed se)ual impulses *an)iety is to repressed libido, he wrote, Das vinegar is to wineE+. &ater in his career,
he argued that an)iety primarily arose #rom unconscious psychic con#licts. &ate in his li#e, in &he Problem of nxiety, 'reud wrote7
DIt is almost disgrace#ul that a#ter so much labor we should still #ind di##iculty in conceiving o# the most #undamental matters.E
,oday, the 9merican sychiatric 9ssociations 4iagnosti% and /tatisti%al $anual *now in its 6ust$published #i#th edition, 4/$"5+
de#ines hundreds o# mental disorders, classi#ies them by type, and lists, in levels o# detail that can seem both absurdly precise and
completely random, the symptoms a patient must display *how many, how o#ten, and with what severity+ to receive any given
psychiatric diagnosis. 9ll o# which lends the appearance o# scienti#ic validity to the diagnosing o# an an)iety disorder. 8ut the reality
is that there is a large 1uotient o# sub6ectivity here *both on the part o# patients, in describing their symptoms, and o# clinicians, in
interpreting them+. Studies in the 324.s #ound that when two psychiatrists evaluated the same patient, they gave the same 4/$
diagnosis only about I. percent o# the time. Gates o# consistency have improved since then, but the diagnosis o# many mental
disorders remains, despite pretensions to the contrary, more art than science.
In the spring o# -..I, such was my terror over the looming boo% tour that I sought help #rom multiple sources. I #irst went to a
prominent Harvard psychopharmacologist. D<ou have an an)iety disorder,E he told me a#ter ta%ing my case history. D'ortunately,
this is highly treatable. ;e 6ust need to get you properly medicated.E ;hen I gave him my standard ob6ections to reliance on
medication *worry about side e##ects, concerns about drug dependency, discom#ort with the idea o# ta%ing pills that might a##ect my
mind and change who I am+, he resorted to the clichQd/but nonetheless potent/diabetes argument, which goes li%e this7 D<our
an)iety has a biological, physiological, and genetic basis0 it is a medical illness, 6ust li%e diabetes is. I# you were a diabetic, you
wouldnt have such 1ualms about ta%ing insulin, would you: 9nd you wouldnt see your diabetes as a moral #ailing, would you:E Id
had versions o# this discussion with various psychiatrists many times over the years. I would try to resist whatever the latest drug
15
was, #eeling that this resistance was somehow noble or moral, that reliance on medication evinced wea%ness o# character, that my
an)iety was an integral and worthwhile component o# who I am, and that there was redemption in su##ering/until, inevitably, my
an)iety would become so acute that I would be willing to try anything, including the new medication. So, as usual, I capitulated, and
as the boo% tour drew closer, I began a course o# benzodiazepines *(ana) during the day, Clonopin at night+ and increased my
dosage o# "ele)a, an antidepressant I was already ta%ing.
8ut even drugged to the gills, I remained #illed with dread about the boo% tour, so I went also to the 8oston Hniversity center, and
was ultimately re#erred to a young but highly regarded Stan#ord$trained psychologist who specialized in cognitive$behavioral
therapy. D'irst thing weve got to do,E she said in one o# my early sessions with her, Dis to get you o## these drugs.E 9 #ew sessions
later, she o##ered to ta%e my (ana) #rom me and loc% it in a drawer in her des%. She opened the drawer to show me the bottles
deposited there by some o# her other patients, holding one up and sha%ing it #or e##ect. ,he drugs, she said, were a crutch that
prevented me #rom truly e)periencing and thereby con#ronting my an)iety0 i# I didnt e)pose mysel# to the raw e)perience o# an)iety,
I would never learn that I could cope with it on my own.
She had a point, I %new. 8ut with the boo% tour approaching, my #ear was that I might not, in #act, be able to cope with it.
I went bac% to the Harvard psychopharmacologist *lets call him ?r. Harvard+ and described the course o# action the Stan#ord
psychologist *lets call her ?r. Stan#ord+ had proposed. D<ou could try giving up the medication,E he said. D8ut your an)iety is clearly
so deeply rooted in your biology that even mild stress provo%es it. =nly medication can control your biological reaction. 9nd it may
well be that your an)iety is so acute that the only way youll be able to get to the point where any %ind o# behavioral therapy can
begin to be e##ective is by ta%ing the edge o## your physical symptoms with drugs.E
9t my ne)t session with ?r. Stan#ord, I told her I was a#raid to give up my (ana) and related what ?r. Harvard had said to me. She
loo%ed betrayed. 9#ter that, I stopped telling her about my visits to ?r. Harvard. My continued consultations with him #elt illicit.
?r. Stan#ord was more pleasant to tal% to than ?r. Harvard0 she tried to understand what caused my an)iety and seemed to care
about me as an individual. ?r. Harvard seemed to see me as more o# a general type/an an)iety patient/to be treated with drugs.
=ne day I read in the newspaper that he was administering antidepressants to gorillas at the local zoo. ?r. Harvards treatment o#
choice #or the gorillas in 1uestion: SSGI antidepressants, the same class o# medication he had prescribed #or me.
I cant say #or certain whether the drugs wor%ed #or the gorillas. Geportedly, they did not. 8ut could there be a more potent
demonstration that ?r. Harvards approach to treatment was resolutely biological: 'or him, the content o# any psychic distress/and
certainly the meaning o# it/mattered less than the #act o# it7 such distress, whether in a human or some other primate, was a
medical$biological mal#unction that could be #i)ed with drugs.
Aot all therapists have such blac%$and$white views0 many #ind room both #or medication and #or other %inds o# therapy. Some
cognitive$behavioral therapists, #or instance, use certain drugs to enhance e)posure therapy. 9nd neuroscientists increasingly
recognize the power o# things li%e meditation and traditional tal% therapy to render concrete structural changes in brain physiology
that are every bit as DrealE as the changes wrought by pills or electroshoc% therapy.
16
Even as a high$school student, the author still struggled with severe separation an)iety, ma%ing it hard #or him to spend e)tended
time away #rom home and #amily. *"ourtesy o# the Stossel #amily+
My own e)perience, o# course, involves ample e)posure to both drugs and other therapies, o#ten in concert. Starting when I was 33, I
saw the same psychiatrist once or twice a wee% #or -4 years. ?r. &. was the psychiatrist who, when I was ta%en to Mc&ean Hospital,
administered my #irst Gorschach test. ;hen I started therapy with him, he was approaching 4., tall and lan%y, balding a little, with a
beard in the classic 'reudian style. =ver the years, the beard came and went, and he lost more o# his hair, which turned #rom brown
to salt$and$pepper to white. ,rained at Harvard in the 324.s and early 32J.s, ?r. &. came o# pro#essional age in the late stages o# the
psychoanalytic heyday, when 'reudianism still dominated. ;hen I #irst encountered him, he was a believer both in medication and
in such 'reudian concepts as neurosis and repression, the =edipus comple) and trans#erence. =ur #irst sessions, in the early 32F.s,
were #illed with things li%e Gorschach tests and #ree association and discussions o# early memories. =ur last sessions, in the mid$
-...s, were #ocused on role$playing and Denergy wor%E0 he also suggested during those latter years that I sign up #or a special %ind
o# yoga program, later alleged to be a brainwashing cult by some #ormer members, though their claims were never proved.
Heres some o# what we did in our sessions together over a 1uarter century7 loo%ed at picture boo%s *32F3+0 played bac%gammon
*32F-PF4+0 played darts *32F4PFF+0 e)perimented sporadically with various cutting$edge psychotherapeutic methods o# an
increasingly Aew 9ge comple)ion, such as hypnotism, eye$movement desensitization and reprocessing, energy$systems therapy, and
internal$#amily$systems therapy *32FFP-..I+. ?uring this period I also moved, in tandem with prevailing pharmacological trends,
#rom one class o# drugs to another, in o#ten overlapping succession7 #rom antipsychotics to benzodiazepines to tricyclic
antidepressants to M9=I antidepressants to SSGI antidepressants bac% to benzodiazepines again. I was the bene#iciary, or possibly
the victim, o# seemingly every passing #ad in psychotherapy and psychopharmacology.
Medication has more reliably soothed my an)iety than various other #orms o# therapy have. *;ithout ,horazine and imipramine and
@alium, I dont %now that I could have gotten through seventh grade.+ <et the case #or medication, I can also tell you, is complicated
by drawbac%s and side e##ects that range #rom sedation to weight gain to mania to headaches to digestive and urinary troubles to
neuromuscular problems to dependency and addiction to, some say, brain damage/and thats leaving aside withdrawal symptoms
17
that, in the case o# many drugs, can be #ar worse than the side e##ects. ;hile lots o# people will testi#y that drugs have helped them,
lots o# other people will testi#y *and o#ten do, in court #ilings and be#ore "ongress+ that medication has ruined their lives. ,hough
plenty o# studies, and many individual e)periences, suggest that drugs can be highly e##ective in treating an)iety, the bene#its are at
the very least not clear$cut.
Sigmund 'reud relied heavily on drugs to manage his an)iety. Si) o# his earliest scienti#ic papers described the bene#its o# cocaine,
which he used regularly #or at least a decade, beginning in the 3FF.s. =nly a#ter he prescribed the stimulant to a close #riend who
became #atally addicted did 'reuds enthusiasm wane. Much o# the history o# modern psychopharmacology has the same ad hoc
1uality as 'reuds e)perimentation with cocaine. Every one o# the most commercially signi#icant classes o# antian)iety and
antidepressant drugs o# the past J. years was discovered by accident or was originally developed #or something completely
unrelated to an)iety or depression7 to treat tuberculosis, surgical shoc%, allergies0 to use as an insecticide, a penicillin preservative,
an industrial dye, a disin#ectant, roc%et #uel.
rozac and other, similar selective serotonin reupta%e inhibitors are currently the medications o# choice #or many psychiatrists, and
have been #or more than two decades. Kiven how completely SSGIs have saturated our culture and our environment, you might be
surprised to learn that Eli &illy, which held the H.S. patent #or #luo)etine *the generic name #or rozac+, %illed the drug in
development seven times, in part because o# unconvincing test results. 9#ter e)amining the tepid outcomes o# #luo)etine trials, as
well as complaints about the drugs side e##ects, Kerman regulators in 32FI concluded, D"onsidering the bene#it and the ris%, we
thin% this preparation totally unsuitable #or the treatment o# depression.E Early clinical trials o# another SSGI, a)il, were also
#ailures.
Ive been on one or another SSGI pretty much continuously #or going on -. years. Aevertheless, I cant say with complete conviction
that these drugs have wor%ed, at least #or long/or that theyve been worth the costs in terms o# money, side e##ects, drug$switching
traumas, and who %nows what long$term e##ects on my brain.
9#ter the initial #lush o# enthusiasm #or SSGIs in the 322.s, some o# the concerns about drug dependency and side e##ects that had
attached to tran1uilizers in the 32>.s began clustering around antidepressants. DIt is now clear,E ?avid Healy, a historian o#
psychopharmacology, wrote in -..5, Dthat the rates at which withdrawal problems have been reportedE on paro)etine, the generic
name #or a)il, De)ceed the rates at which withdrawal problems have been reported on any other psychotropic drug ever.E
Even leaving aside withdrawal e##ects, there is now a large pile o# evidence suggesting/in line with those early studies o# the
ine##ectiveness o# rozac and a)il/that SSGIs may not wor% terribly well. In !anuary -.3., almost e)actly -. years a#ter hailing the
arrival o# SSGIs with its cover story Drozac7 9 8rea%through ?rug #or ?epression,E #ewsweek published a cover story about the
growing number o# studies that suggested these and other antidepressants are barely more e##ective than sugar pills. 9 large$scale
study #rom -..J showed that only about a third o# patients improved dramatically a#ter a #irst cycle o# treatment with
antidepressants. Even a#ter three additional cycles, almost a third o# patients who remained in the study had not reached remission.
9#ter reviewing a host o# studies on antidepressant e##ectiveness, a paper in the 6ritish $edi%al 7ournal concluded that drugs in the
SSGI class/including rozac, Bolo#t, and a)il/Ddo not have a clinically meaning#ul advantage over placebo.E
How can this be: ,ens o# millions o# 9mericans/including me and many people I %now/collectively consume billions o# dollars
worth o# SSGIs each year. ?oesnt this suggest that these drugs are e##ective: Aot necessarily. 9t the very least, this massive rate o#
SSGI consumption has not caused rates o# sel#$reported depression to go down/and in #act all o# this pill popping seems to correlate
with substantially higher rates o# depression. Meanwhile, the relationship between low serotonin levels and an)iety or depression
*once, and to some e)tent still, the theoretical reason SSGIs, which boost serotonin, should wor%+ now seems less straight#orward
than previously thought. Keorge 9shcro#t, who, as a research psychiatrist in Scotland in the 324.s, was one o# the scientists
18
responsible #or promulgating the chemical$imbalance theory o# mental illness, abandoned the theory when #urther research #ailed to
support it. D;e have hunted #or big, simple neurochemical e)planations #or psychiatric disorders,E Cenneth Cendler, a co$editor o#
Psy%hologi%al $edi%ine and a psychiatry pro#essor at @irginia "ommonwealth Hniversity, conceded in -..4, Dand have not #ound
them.E
Some drugs wor% on some people, but the reasons are mur%y, and the results sometimes #leeting. =# course, studies have generally
not #ound the response rates to nonpharmacological #orms o# treatment to be better than the response rates to antidepressants or
any other drugs. Some recent studies have #ound that the e##ects o# cognitive$behavioral therapy are more enduring than drug
treatment. 8ut as a general rule o# thumb across many types o# therapy, patients tend to split pretty evenly among those who see
long$term improvement, those who see only transient bene#its, and those who see no improvement at all. *,hats generally true o#
placebo treatments as well.+ 9nd so, 6ust as I #ind it di##icult to endorse most o# these treatments, I am also reluctant to condemn
them. &i%e medication, they clearly do help some patients. ,his is a #act I can vouch #or personally.
=n the Sunday in the autumn o# 3224 when my mother announced to him that she might want a divorce, my #ather, desperate to
save the marriage, and in a gesture that was completely out o# character, ac1uiesced to emergency couples counseling. ;hen that
didnt wor%, and my mother le#t him, he became unmoored, and soon began seeing ?r. &., my psychiatrist. 'or years be#ore that, my
#ather, despite #ooting the bill #or my sisters and my shrin%s, had disdained psychotherapy. DHow was your wac%o lesson:E hed as%
6eeringly a#ter Id had an appointment. He did this so o#ten that the term became a part o# the #amilys lingua #ranca, and eventually
my sister and I were re#erring without irony to our wac%o lessons. *DMom, can you give me a ride to my wac%o lesson on
;ednesday:E+
9nd yet, there he was, suddenly sharing a therapist with me. My own sessions with ?r. &. came to be dominated by the therapists
1uestions about his new star patient, my #ather. I couldnt blame ?r. &. #or #inding my #ather the more interesting patient. 9#ter all,
while hed been seeing me #or more than 34 years, hed been seeing my dad #or only a #ew months. My dad entered therapy
emotionally wrec%ed by his separation, pro#oundly sha%en, and newly sober. He completed therapy less than two years later, happy,
productive, remarried, and deemed *by himsel# and by ?r. &.+ to be much more Dsel#$actualizedE and DauthenticE than he had been
be#ore. He was in and out o# therapy in 3F months. ;hereas I was entering my 3Fth year o# therapy with ?r. &. and was still as
an)ious as ever.
9t some level, it is adaptive to be reasonably an)ious. 9ccording to "harles ?arwin *who himsel# seems to have su##ered #rom
crippling agoraphobia that le#t him intermittently housebound #or years a#ter his voyage on the 6eagle+, species that e)perience an
appropriate amount o# #ear increase their chances o# survival. ;e an)ious people are less li%ely to remove ourselves #rom the gene
pool by, say, #rolic%ing on the edges o# cli##s or becoming #ighter pilots.
9n in#luential study conducted 3.. years ago by two Harvard psychologists, Gobert M. <er%es and !ohn ?illingham ?odson, laid the
#oundation #or the idea that moderate levels o# an)iety improve per#ormance7 too much an)iety, obviously, and per#ormance is
impaired, but too little an)iety also impairs per#ormance. D;ithout an)iety, little would be accomplished,E ?avid 8arlow, the
#ounder and director emeritus o# the "enter #or 9n)iety and Gelated ?isorders at 8oston Hniversity, has written.
,he per#ormance o# athletes, entertainers, e)ecutives, artisans, and students would su##er0 creativity would diminish0 crops might
not be planted. 9nd we would all achieve that idyllic state long sought a#ter in our #ast$paced society o# whiling away our lives under
a shade tree. ,his would be as deadly #or the species as nuclear war.
Even i# I cant #ully recover #rom my an)iety, Ive come to believe there may be some redeeming value in it.
19
Historical evidence suggests that an)iety can be allied to artistic and creative genius. ,he literary gi#ts o# Emily ?ic%inson, #or
e)ample, were ine)tricably bound up with her reclusiveness, which some say was a product o# an)iety. *She was completely
housebound a#ter age I..+ 'ranz Ca#%a yo%ed his neurotic sensibility to his artistic sensibility0 ;oody 9llen has done the same.
!erome Cagan, an eminent Harvard psychologist who has spent more than 4. years studying human temperament, argues that
,. S. Eliots an)iety and Dhigh reactiveE physiology helped ma%e him a great poet. Eliot was, Cagan observes, a Dshy, cautious,
sensitive childE/but because he also had a supportive #amily, good schooling, and Dunusual verbal abilities,E Eliot was able to
De)ploit his temperamental pre#erence #or an introverted, solitary li#e.E
erhaps most #amously, Marcel roust transmuted his neurotic sensibility into art. rousts #ather, 9drien, was a physician with a
strong interest in nervous health and a co$author o# an in#luential boo% called &he (ygiene of the #eurastheni%. Marcel read his
#athers boo%, as well as boo%s by many o# the other leading nerve doctors o# his day, and incorporated their wor% into his0 his #iction
and non#iction are Dsaturated with the vocabulary o# nervous dys#unction,E as one historian has put it. 'or roust, re#inement o#
artistic sensibility was directly tied to a nervous disposition. ?ean Simonton, a psychology pro#essor at the Hniversity o# "ali#ornia at
?avis who has spent decades studying the psychology o# genius, has written that De)ceptional creativityE is o#ten lin%ed to
psychopathology0 it may be that the same cognitive or neurobiological mechanisms that predispose certain people to developing
an)iety disorders also enhance creative thin%ing.
Many o# historys most eminent scientists also su##ered #rom an)iety or depression, or both. ;hen Sir Isaac Aewton invented
calculus, he didnt publicize his wor% #or -. years/because, some con6ecture, he was too an)ious and depressed to tell anyone. *'or
more than #ive years a#ter a nervous brea%down around 3J>F, when he was in his mid$5.s, he rarely ventured #ar #rom his room at
"ambridge.+ erhaps i# ?arwin had not been largely housebound by his an)iety #or decades on end, he would never have been able
to #inish his wor% on evolution. Sigmund 'reuds career was nearly derailed early on by his terrible an)iety and sel#$doubt0 he
overcame it, and once his reputation as a great man o# science had been established, 'reud and his acolytes sought to portray him as
the eternally sel#$assured wise man. 8ut his early letters reveal otherwise.
Ao, an)iety is not, by itsel#, going to ma%e you a Aobel rizePwinning poet or a groundbrea%ing scientist. 8ut i# you harness your
an)ious temperament correctly, it might ma%e you a better wor%er. !erome Cagan says he hires only people with high$reactive
temperaments as research assistants. D,heyre compulsive, they dont ma%e errors,E he told &he #ew York &imes. =ther research
supports Cagans observation. 9 -.35 study in the %ademy of $anagement 7ournal, #or instance, #ound that neurotics contribute
more to group pro6ects than co$wor%ers predict, while e)troverts contribute less. 9nd in -..4, researchers in the Hnited Cingdom
published a paper, D"an ;orriers 8e ;inners:,E reporting that #inancial managers high in an)iety tended to be the best, most
e##ective money managers, as long as their worrying was accompanied by a high IR.
$y anxiety %an be intolerable. 6ut it is also, maybe, a gift3or at least the other side of a %oin I ought to think twi%e about before
trading in.
Hn#ortunately, the positive correlation between worrying and 6ob per#ormance disappeared when the worriers had a low IR. 8ut
some evidence suggests that e)cessive worrying is itsel# allied to intelligence. !eremy "oplan, the lead author o# one study
supporting that thesis, says an)iety is evolutionarily adaptive because Devery so o#ten theres a wild$card danger.E ;hen such a
danger arises, an)ious people are more li%ely to be prepared to survive. "oplan, a pro#essor o# psychiatry at the State Hniversity o#
Aew <or% ?ownstate Medical "enter, has said that worrying can be a good trait in leaders/and that lac% o# worrying can be
dangerous. I# people in leadership positions are Dincapable o# seeing any danger, even when danger is imminent,E they are li%ely,
among other poor decisions, to Dindicate to the general populace that theres no need to worry.E *Some commentators have
suggested, based on #indings li%e "oplans, that the main cause o# the economic crash o# -..F was politicians and #inanciers who
were either stupid or insu##iciently an)ious or both.+ Studies on rhesus mon%eys by Stephen Suomi, the chie# o# the &aboratory o#
"omparative Ethology at the Aational Institutes o# Health, have #ound that when mon%eys genetically predisposed to an)iety were
20
ta%en early in li#e #rom their an)ious mothers and given to unan)ious mothers to be raised, a #ascinating thing happened7 these
mon%eys grew up to display less an)iety than peers with the same genetic mar%ings/and many also, intriguingly, became the leader
o# their troop. ,his suggests that, under the right circumstances, some 1uotient o# an)iety can e1uip you to be a leader.
9s always, all o# this comes with the proviso that an)iety is productive mainly when it is not so strong as to be debilitating. 8ut i# you
are an)ious, perhaps you can ta%e heart #rom these #indings.
Ive come to understand that my own nervous disposition is perhaps an essential part o# my being/and not 6ust in ways that are bad.
DI hate your an)iety,E my wi#e once said, Dand I hate that it ma%es you unhappy. 8ut what i# there are things that I love about you
that are connected to your an)iety:
D;hat i#,E she as%ed, getting to the heart o# the matter, Dyoure cured o# your an)iety and you become a total 6er%:E
I suspect I might. Military pilots, by reputation, at least, are #amously unan)ious. 9nd one small$scale study #rom the 32F.s #ound
that nine out o# 3. separations and divorces among 9ir 'orce pilots were initiated by wives. erhaps the two are lin%ed. &ow baseline
levels o# autonomic arousal *which can correspond to low levels o# an)iety+ have been tied not only to a need #or adventure *#lying a
#ighter plane, say+, but also to a certain interpersonal obtuseness, a lac% o# sensitivity to social cues. It may be that my an)iety lends
me an inhibition and a social sensitivity that ma%e me more attuned to other people and a more tolerable spouse than I otherwise
would be.
,he notion o# a connection between an)iety and morality long predates the #indings o# modern science or my wi#es intuition. Saint
9ugustine believed #ear is adaptive because it helps people behave morally. ,he novelist 9ngela "arter has called an)iety Dthe
beginning o# conscience.E Some research into the determinants o# criminal behavior suggest that criminals tend to be lower in
an)iety than noncriminals. *=n the other hand, di##erent studies have #ound that high levels o# an)iety, especially in youth, correlate
with delin1uent behavior.+
My an)iety can be intolerable. 8ut it is also, maybe, a gi#t/or at least the other side o# a coin I ought to thin% twice about be#ore
trading in. 9s o#ten as an)iety has held me bac%/prevented me #rom traveling, or #rom seizing opportunities or ta%ing certain ris%s
/it has also un1uestionably spurred me #orward. DI# a man were a beast or an angel, he would not be able to be in an)iety,E SOren
Cier%egaard wrote in 3FII. DSince he is a synthesis, he can be in an)iety, and the greater the an)iety, the greater the man.E I dont
%now about that. 8ut I do %now that some o# the things #or which I am most than%#ul/the opportunity to help lead a respected
magazine0 a place, however peripheral, in shaping public debate0 a peripatetic and curious sensibility0 and whatever 1uotients o#
emotional intelligence and good 6udgment I possess/not only coe)ist with my condition but are in some meaning#ul way the
product o# it.
In his 32I3 essay D,he ;ound and the 8ow,E the literary critic Edmund ;ilson writes o# the Sophoclean hero hiloctetes, whose
suppurating, never$healing sna%ebite wound on his #oot is lin%ed to a gi#t #or unerring accuracy with his bow and arrow/his
Dmalodorous diseaseE is inseparable #rom his Dsuperhuman artE #or mar%smanship. I have always been drawn to this parable7 in it
lies, as the writer !eanette ;interson has put it, Dthe nearness o# the wound to the gi#t,E the insight that in wea%ness and
shame#ulness is also the potential #or transcendence, heroism, or redemption. My an)iety remains an unhealed wound that, at times,
holds me bac% and #ills me with shame/but it may also be, at the same time, a source o# strength and a bestower o# certain blessings.
Scott Stossel is the editor o# &he tlanti% and the author o# /arge8 &he 9ife and &imes of /argent /hriver. ,his essay is adapted #rom
his new boo%, $y ge of nxiety8 *ear, (ope, 4read, and the /ear%h for Pea%e of $ind, to be published !anuary > by Cnop#.