My Age of Anxiety Summary

What does it mean to live with anxiety so intense that everyday actions can feel impossible? Scott Stossel takes us on a personal and scientific journey to understand the condition that shapes his life and the lives of millions.

1. Anxiety affects more people than you might think

Anxiety is not just occasional nervousness; clinical anxiety is a pervasive condition that impacts millions of people globally. In fact, it is the most commonly diagnosed mental illness worldwide, even more so than depression. Statistics show that about one out of six people will experience clinical anxiety for at least a year during their lifetime. This highlights how widespread and deeply ingrained anxiety disorders are within human populations.

Cultural and historical references also demonstrate that anxiety is a shared human experience across ages and societies. Ancient Greek philosophers like Plato and Hippocrates theorized about it, and Freud, a more modern thinker, sought to understand its mechanisms. The prevalence of culturally specific terms, such as "kayak angst" among Greenland Inuit or "ataques de nervios" in Spanish-speaking cultures, underlines how anxiety transcends traditional boundaries.

Despite its prevalence, society often underestimates the seriousness of clinical anxiety. Yet, prominent figures like Gandhi, Barbra Streisand, and Charles Darwin lived successful lives while battling anxiety. Even the author, despite his crippling anxiety, has built a reputable career. This reveals that while anxiety is vastly impactful, it does not strip individuals of their ability to contribute meaningfully to the world.

Examples

• 40 million Americans are diagnosed with anxiety.
• In South America, anxiety is culturally acknowledged as "ataques de nervios."
• Figures like Gandhi struggled with anxiety yet achieved monumental success.

2. Living with anxiety is a daily struggle

For people with clinical anxiety, life can feel like an uphill battle. Normal daily activities, like leaving the house or speaking in public, often trigger overwhelming fear and physical symptoms. This makes even basic aspects of life difficult to manage. For instance, some people develop such severe anxiety that going outside a specific area around their home becomes impossible.

Clinical anxiety often traps individuals in cycles of fear and avoidance. The author, for example, finds it nearly impossible to fly on airplanes or speak before an audience without medications and alcohol. This condition can make sufferers housebound or constantly on edge as they try to avoid potential triggering scenarios.

Embarrassment can also accompany episodes of anxiety, making the condition even more isolating. The author recounts moments like flooding the bathroom at the Kennedy family’s home due to stress-induced digestive issues. These episodes amplify the feelings of shame and alienation already present in people struggling with anxiety.

Examples

• A man suffering from severe anxiety vomited blood when trying to walk outside his home.
• The author struggled to separate from his parents as a child and constantly feared abandonment.
• While visiting the Kennedy family, extreme stress caused the author to accidentally flood their bathroom.

3. Childhood experiences play a key role in developing anxiety

Many researchers believe that anxiety has roots in early childhood experiences. Psychoanalytic theories suggest that hidden desires and fears, often from a young age, influence adult anxiety. For example, Freud theorized that unresolved feelings from childhood, such as the Oedipus complex, caused many of his adult phobias. While this theory has since been dismissed, it brought attention to the impact of formative years on mental health.

Parental relationships also carry significant weight. Studies reveal that children who experience separation from nurturing figures, such as mothers, tend to show higher levels of anxiety as adults. This was famously illustrated in experiments with Rhesus monkeys, where separated young displayed anxious and aggressive behavior, ultimately becoming socially impaired.

The author points to his own anxious mother as a probable influence on his struggles. Her phobic behaviors likely shaped his predisposition to anxiety, despite her love and care for him. Such observations suggest parenting styles and early attachments deeply impact long-term emotional wellbeing.

Examples

• Rhesus monkeys separated from mothers developed lifelong anxiety and social issues.
• One study showed caring mothers helped reduce their children's anxiety in stressful situations.
• The author connected his mother’s phobias to his own lifelong anxiety battle.

4. Anxiety may have evolutionary roots

Anxiety might actually be linked to survival mechanisms. Evolutionarily speaking, fear and anxiety serve as protective functions. Being afraid of predators, heights, or venomous creatures kept ancient humans alive. These natural fears are coded in our genes, ensuring the survival of cautious individuals.

However, clinical anxiety is different. It often involves irrational fears—things not immediately life-threatening, such as public speaking or, in the author's case, cheese. The disparity between ancient survival instincts and modern anxiety highlights how these mechanisms can sometimes misfire, creating harmful behaviors instead of helpful ones.

Evidence for anxiety being genetically hardwired comes from studies showing its presence in newborns only weeks after birth. About 15–20% of infants show elevated levels of fear compared to their peers, which often continues into adulthood. The author also notes these patterns in his daughter, who shares many of his own phobias despite different life experiences.

Examples

• Fear of snakes or cliffs helped early humans survive.
• Infants displaying high anxiety levels often grow into anxious adults.
• The author’s daughter inherited his fear of specific objects, demonstrating a genetic link.

5. Brain chemistry drives anxiety responses

From a physiological standpoint, anxiety is deeply connected to brain activity. Neurotransmitters, especially serotonin, regulate emotions like happiness and satisfaction. In people with clinical anxiety, serotonin levels are often lower, creating a physical imbalance that perpetuates stress and worry.

Brain scans further reveal heightened activity in specific regions during anxiety episodes. For example, public speaking fears often link to increased anterior cingulate cortex activity, while worrying about the future can involve the frontal lobes. These scans confirm anxiety isn't just "in the mind" but linked to clear biological processes.

The author discusses his own dependence on medications like Xanax that interact with brain systems to reduce his symptoms. These drugs target neurotransmitters to calm the central nervous system, though they come with risks like side effects and potential addiction.

Examples

• Lower serotonin levels in the brain correlate with increased anxiety.
• The anterior cingulate cortex shows heightened activity with fear of speaking.
• Drugs like Xanax manipulate neurotransmitters to calm anxiety symptoms.

6. Many treatments for anxiety exist, but none are perfect

Various types of treatment exist for anxiety, ranging from medication to therapy. While medications like Xanax and Paxil can alleviate symptoms, they often produce side effects and risk addiction. Additionally, only about a third of users report significant improvement.

Alternatively, cognitive behavioral therapy (CBT) encourages techniques like exposure therapy. Exposure therapy invites the patient to face their fears, with the belief that confronting anxiety-inducing situations gradually lessens their grip. Although CBT has shown results, it doesn’t always work for everyone. The author recounts a failed exposure session involving emetic drugs designed to help his phobia of vomiting, which ended in a choking incident instead.

Ultimately, no single solution fits all patients. The journey of managing anxiety often involves combining efforts: medications, therapy, and support networks. While the author has not "cured" his condition, he continues to adapt through these combined methods.

Examples

• Many anxiety medications have adverse side effects and can lead to addiction.
• The author's exposure therapy with emetics failed disastrously.
• CBT incorporates methods like journaling fear hierarchies during therapy sessions.

Takeaways

1. Approach treatment from multiple angles—combine therapy, medication, and supportive habits for the best results.
2. Understand that anxiety doesn’t define worth; individuals can achieve fulfilling lives even with ongoing struggles.
3. Grow awareness of childhood environments and genetic tendencies to address or prevent heightened anxiety in future generations.