Introduction
In "My Age of Anxiety," Scott Stossel takes readers on a deeply personal journey through the world of clinical anxiety. As both a sufferer and a journalist, Stossel provides a unique perspective on this common yet often misunderstood mental illness. This book is not just a memoir of his struggles with anxiety, but also a comprehensive exploration of the history, science, and cultural impact of anxiety disorders.
The Prevalence and Universality of Anxiety
Stossel begins by highlighting the surprising prevalence of clinical anxiety in modern society. It's not just a matter of occasional nervousness or worry; clinical anxiety is the most common form of mental illness, even surpassing depression in its frequency. In fact, one out of six people worldwide will experience clinical anxiety for at least a year in their lifetime.
What's particularly interesting is that anxiety seems to transcend cultural and temporal boundaries. Different cultures may have different names for it - from "ataques de nervios" in Spanish-speaking South America to "kayak angst" among Greenland Inuit - but the underlying experience is remarkably similar. This universality extends through history as well, with anxiety being a topic of discussion for thinkers ranging from Plato and Hippocrates to Spinoza and Freud.
Stossel emphasizes that anxiety is not a character flaw or a sign of weakness. In fact, he argues that it might even be the driving force behind civilization, creativity, and inventive genius. He points out that many highly successful and influential figures throughout history, including Gandhi, Charles Darwin, and Barbra Streisand, have grappled with anxiety.
Living with Clinical Anxiety
The author provides a vivid and often painful description of what it's like to live with clinical anxiety. He compares it to living with a chronic illness like diabetes, requiring constant vigilance and management. For those with severe anxiety, even basic daily activities can become monumental challenges.
Stossel shares his own experiences, describing how he can't board an airplane or speak in public without a combination of medication and alcohol. He recounts embarrassing incidents, such as visiting nearly every public restroom in a foreign town due to stress-induced digestive issues, or accidentally flooding the Kennedy family's bathroom during a visit.
The impact of anxiety on relationships is also explored. Anxious individuals often struggle with attachment, becoming overly dependent on loved ones. Stossel recalls how, as a child, he would panic when separated from his parents, even calling their friends to check if his parents were still alive when they were away.
Theories on the Origins of Anxiety
Stossel delves into various theories about the causes of anxiety, starting with psychoanalytic perspectives. He discusses Freud's Oedipus complex theory, which suggests that anxiety stems from the repression of taboo thoughts arising in childhood. While this particular theory is now considered outdated, it illustrates the long-standing interest in understanding the roots of anxiety.
More contemporary theories focus on the role of early childhood experiences, particularly the mother-child relationship. Studies have shown that children who experience longer separations from their mothers tend to become more anxious. The way a mother interacts with her child also seems to play a crucial role in determining how the child will respond to stressful situations later in life.
Stossel reflects on his own upbringing, noting that his mother was anxious and phobic herself, which may have influenced his own predisposition to anxiety. This personal anecdote underscores the complex interplay between nature and nurture in the development of anxiety disorders.
Anxiety as an Evolutionary Adaptation
One of the most intriguing aspects of anxiety explored in the book is its potential evolutionary origins. Stossel explains that a certain level of anxiety can be seen as an adaptive trait that has helped ensure human survival. The "survival of the fittest" theory suggests that we are programmed to be anxious about potentially dangerous situations or objects, such as snakes or heights.
However, clinical anxiety takes this adaptive trait to an extreme. People with anxiety disorders often fear things that aren't inherently dangerous, and their reactions are disproportionate to the actual threat. Stossel humorously illustrates this point with his own phobia of cheese, acknowledging that such a fear serves no evolutionary purpose.
The Genetic Component of Anxiety
Building on the evolutionary perspective, Stossel explores the genetic basis of anxiety. He cites studies showing that the propensity for anxiety can be observed in infants as young as a few weeks old, suggesting a strong genetic component. Approximately 15 to 20 percent of infants show significantly higher levels of anxiety than their peers, and these same individuals often grow up to be anxious adults.
Stossel shares his personal observations of genetic influence, noting similarities between his own anxiety and that of his daughter, who seems to have inherited some of his specific phobias despite being raised in a loving, supportive environment.
The book also delves into the specific genes that have been linked to anxiety. For example, the stathmin gene is associated with the ability to feel fear, while variants of the RGS2 gene have been correlated with higher levels of anxiety. This genetic research provides valuable insights into the biological underpinnings of anxiety disorders.
The Physiology of Anxiety and Drug Treatments
Stossel takes readers on a tour of the anxious brain, explaining how modern imaging techniques like functional Magnetic Resonance Imaging (fMRI) have allowed scientists to observe anxiety in action. These scans reveal increased activity in specific brain regions during anxious states, such as the frontal lobes of the cerebral cortex when worrying about future events, or the anterior cingulate when experiencing fear of public speaking.
The book also explores the role of neurotransmitters in anxiety, particularly focusing on serotonin. People with clinical anxiety tend to produce less serotonin than those without the disorder, which has led to the development of various medications aimed at influencing neurotransmitter levels in the brain.
Stossel provides a balanced discussion of anti-anxiety medications, acknowledging their popularity while also highlighting their controversies. He mentions drugs like Xanax and Ativan, explaining how they work by binding to GABA neurotransmitters to produce a calming effect. However, he also points out the potential side effects, risk of addiction, and studies suggesting that these drugs may not be significantly more effective than placebos for many patients.
The author shares his own experiences with medication, including his struggles with addiction to anti-anxiety drugs. His candid account of attempting to go without medication, only to return to it after a week due to unbearable symptoms, illustrates the complex relationship many anxiety sufferers have with their prescribed treatments.
Therapeutic Approaches to Anxiety
While medication plays a significant role in treating anxiety, Stossel also explores non-pharmacological approaches, particularly cognitive behavioral therapy (CBT). He explains that CBT is based on the idea that certain behaviors, including anxious responses, can't be controlled through rational thinking alone.
One of the primary techniques used in CBT is exposure therapy, which involves directly confronting feared objects or situations to learn that they aren't actually threatening. Stossel shares his personal experience with exposure therapy for his emetophobia (fear of vomiting), describing a particularly disastrous session where he was given emetics to induce vomiting but ended up choking instead.
The book also delves into more advanced CBT techniques, such as imaginal exposure. Stossel recounts how his therapist used this method to try to uncover deeper, existential fears that might be at the root of his anxiety. These therapy sessions involved listing and visualizing his fears, sometimes leading to unexpected emotional responses that the therapist saw as progress towards understanding the underlying causes of his anxiety.
The Ongoing Battle with Anxiety
Throughout the book, Stossel makes it clear that living with anxiety is an ongoing struggle. He candidly shares that he continues to fight his anxiety using a combination of medication and therapy. While there may not be a universal cure for anxiety, he emphasizes that there are ways to reduce its intensity and impact on daily life.
Stossel's hope in writing this book was not only to better understand his own condition but also to provide insight and comfort to others struggling with anxiety. He stresses that even when anxiety isn't fully under control, it doesn't mean that life with anxiety is a poor or unfulfilling one.
Final Thoughts
"My Age of Anxiety" is a comprehensive and deeply personal exploration of clinical anxiety. Scott Stossel's blend of personal anecdotes, historical context, and scientific research provides readers with a multifaceted understanding of this common mental health condition.
Key takeaways from the book include:
Clinical anxiety is far more prevalent than many people realize, affecting millions of individuals worldwide.
Anxiety has been a part of the human experience throughout history and across cultures, suggesting its deep roots in our biology and psychology.
Living with clinical anxiety can be extremely challenging, impacting every aspect of a person's life from daily activities to relationships.
The origins of anxiety are complex, involving a mix of genetic predisposition, early childhood experiences, and evolutionary adaptations.
While medication can be helpful in managing anxiety, it comes with its own set of challenges and controversies.
Therapeutic approaches like cognitive behavioral therapy offer alternative or complementary treatments to medication.
Despite the difficulties, many people with anxiety lead successful, productive lives, and some even credit their anxiety with driving their achievements.
Understanding and treating anxiety is an ongoing process, with new research constantly shedding light on this complex condition.
Stossel's work serves not only as a memoir of his personal struggles but also as a comprehensive guide to understanding anxiety in its many forms. By sharing his experiences and extensive research, he helps to destigmatize anxiety disorders and offers hope to those who may be silently suffering.
Ultimately, "My Age of Anxiety" reminds us that while anxiety can be a formidable opponent, it is not an insurmountable one. With proper understanding, treatment, and support, individuals with anxiety can lead rich, fulfilling lives, turning their challenges into strengths and their struggles into triumphs.