The Culture, Causes, And Costs Of Anxiety

"Anxiety … makes others feel as you might when a drowning man holds on to you," Anaïs Nin wrote. "Anxiety may be compared with dizziness. He whose eye happens to look down the yawning abyss becomes dizzy," Kierkegaard observed."There is no question that the problem of anxiety is a nodal point at which the most various and important questions converge, a riddle whose solution would be bound to throw a flood of light on our whole mental existence," Freud proclaimed in his classic introductory lectures on psychoanalysis. And yet the riddle of anxiety is far from solved – rather, it has swelled into a social malady pulling countless numbers of us underwater daily. Among those most mercilessly fettered by anxiety's grip is Scott Stossel, familiar to most as the editor of The Atlantic. In his superb mental health memoir, My Age of Anxiety: Fear, Hope, Dread, and the Search for Peace of Mind (public library), Stossel follows in the tradition of Montaigne to use the lens of his own experience as a prism for illuminating insight on the quintessence of our shared struggles with anxiety. From his personal memoir he weaves a cultural one, painting a portrait of anxiety though history, philosophy, religion, popular culture, literature, and a wealth of groundbreaking research in psychology and neuroscience.

Why? Because anxiety and its related psychoemotional disorders turn out to be the most common, prevalent, and undertreated form of clinically classified mental illness today, even more common than depression. Stossel contextualizes the issue with some striking statistics that reveal the cost – both financial and social – of anxiety:

According to the National Institute of Mental Health, some forty million Americans, nearly one in seven of us, are suffering from some kind of anxiety disorder at any given time, accounting for 31 percent of the expenditures on mental health care in the United States. According to recent epidemiological data, the “lifetime incidence” of anxiety disorder is more than 25 percent – which, if true, means that one in four of us can expect to be stricken by debilitating anxiety at some point in our lifetimes. And it is debilitating: Recent academic papers have argued that the psychic and physical impairment tied to living with an anxiety disorder is equivalent to living with diabetes – usually manageable, sometimes fatal, and always a pain to deal with. A study published inThe American Journal of Psychiatry in 2006 found that Americans lose a collective 321 million days of work because of anxiety and depression each year, costing the economy $50 billion annually; a 2001 paper published by the U.S. Bureau of Labor Statistics once estimated that the median number of days missed each year by American workers who suffer from anxiety or stress disorders is twenty-five. In 2005 – three years before the recent economic crisis hit – Americans filled fifty-three million prescriptions for just two antianxiety drugs: Ativan and Xanax. (In the weeks after 9/11, Xanax prescriptions jumped 9 percent nationally – and by 22 percent in New York City.) In September 2008, the economic crash caused prescriptions in New York City to spike: as banks went belly up and the stock market went into free fall, prescriptions for anti-depressant and antianxiety medications increased 9 percent over the year before, while prescriptions for sleeping pills increased 11 percent.

To be sure, this isn't a purely American phenomenon. Stossel points to similar findings in Britain and Canada, for instance – which begs the facetious observation that perhaps speaking English is what is giving us anxiety. In all seriousness, however, the scale of the epidemic is nothing short of gobsmacking. Stossel writes:

Primary care physicians report that anxiety is one of the most frequent complaints driving patients to their offices – more frequent, by some accounts, than the common cold.

[…]

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 as America has been assaulted in short order by terrorism, economic calamity and disruption, and widespread social transformation.

Artwork by Debbie Millman. Details here.

Fittingly, Alan Watts's The Wisdom of Insecurity: A Message for an Age of Anxiety, written in the very atomic era that sparked the dawn of our present predicament, remains one of the best meditations on the subject. But, as Stossel points out, the notion of anxiety as a clinical category only appeared as recently as thirty years ago. He traces anxiety's rise to cultural fame through the annals of academic history, pointing out that there were only three academic papers published on the subject in 1927, only fourteen in 1941, and thirty-seven in 1950. It wasn't until psychologist Rollo May published his influential treatise on anxiety in 1950 that academia paid heed. Today, a simple Google Scholar search returns nearly three million results, and entire academic journals are dedicated to anxiety.

But despite anxiety's catapulting into cultural concern, our understanding of it – especially as far as mental health stereotypes are concerned – remains developmentally stunted, having evolved very little since the time of seventeenth-century Jewish-Dutch philosopher Baruch Spinoza, who asserted that anxiety was a mere problem of logic and could thus be resolved with tools of reason. This is hardly different from present cognitive-behavioral therapy approaches or the all too common just-get-over-it cultural attitude towards this particular problem of mental health, which of course misses the debilitating dimensionality of what makes anxiety as crippling as it is. Looking back on his own messy lineage of Jewishness and Antisemitism and describing himself as "Woody Allen trapped in John Calvin," Stossel counters such oversimplification with a case for layered, complex causality of the disorder:

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.

True to this complexity, different epochs have attributed anxiety to various causes. Stossel probes what these historical patterns reveal:

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?

Today, the definition of Generalized Anxiety Disorder in the DSM-IV – the fourth edition of The Diagnostic Manual of Mental Disorders, the bible of psychotherapy – is at once rather strict yet strangely horoscope-like in its ability to speak to things that feel uncomfortably familiar, at least on some level, to most of us:

Excessive anxiety about a number of events or activities, occurring more days than not, for at least 6 months. The person finds it difficult to control the worry. The anxiety and worry are associated with at least three of the following six symptoms (with at least some symptoms present for more days than not, for the past 6 months):

• Restlessness or feeling keyed up or on edge
• Being easily fatigued
• Difficulty concentrating or mind going blank
• Irritability
• Muscle tension
• Sleep disturbance

Of course, our relationship with anxiety and its potential cures is colored by our culture's characteristic ambivalence. In fact, even Kierkegaard believed that anxiety was a necessary component of creativity and without it, genius would be incomplete. One of the experts Stossel interviews – David Barlow, the founder and director emeritus of Boston University's Center for Anxiety and Related Disorders – echoes this sentiment:

Without anxiety, little would be accomplished. The performance of athletes, entertainers, executives, artisans, and students would suffer; creativity would diminish; crops might not be planted. And we would all achieve that idyllic state long sought after in our fast-paced society of whiling away our lives under a shade tree. This would be as deadly for the species as nuclear war.

The rest of the altogether excellent My Age of Anxiety goes on to explore such facets of our modern epidemic as what anxiety actually is, how early childhood experience might precipitate separation anxiety in adulthood, the promise and perils of antianxiety drugs, and what it takes to cultivate resilience, the trait modern psychology has identified as the most powerful immunization against anxiety and depression. Complement it with Anaïs Nin's illustrated meditation on anxiety and Alan Watts on how to heal the essential anxiety of existence.