Some eighty years ago, Freud proposed that anxiety was "a riddle whose solutionwould be bound to throw a flood of light on our whole mental existence."Unlocking the mysteries of anxiety, he believed, would go far in helping us tounravel the mysteries of the mind: consciousness, the self, identity, intellect,imagination, creativity — not to mention pain, suffering, hope, andregret. To grapple with and understand anxiety is, in some sense, to grapplewith and understand the human condition.
The differences in how various cultures and eras have perceived and understoodanxiety can tell us a lot about those cultures and eras. Why did the ancientGreeks of the Hippocratic school see anxiety mainly as a medical condition,while Enlightenment philosophers saw it as an intellectual problem? Why did theearly existentialists see anxiety as a spiritual condition, while Gilded Agedoctors saw it as a specifically Anglo-Saxon stress response — a responsethat they believed spared Catholic societies — to the IndustrialRevolution? Why did the early Freudians see anxiety as a psychological conditionemanating from sexual inhibition, whereas our own age tends to see it, onceagain, as a medical and neurochemical condition, a problem of malfunctioningbiomechanics?
Do these shifting interpretations represent the forward march of progress andscience? Or simply the changing, and often cyclical, ways in which cultureswork? What does it say about the societies in question that Americans showing upin emergency rooms with panic attacks tend to believe they're having heartattacks, whereas Japanese tend to be afraid they're going to faint? Are theIranians who complain of what they call "heart distress" suffering what Westernpsychiatrists would call panic attacks? Are the ataques de nerviosexperienced by South Americans simply panic attacks with a Latino inflection— or are they, as modern researchers now believe, a distinct cultural andmedical syndrome? Why do drug treatments for anxiety that work so well onAmericans and the French seem not to work effectively on the Chinese?
As fascinating and multifarious as these cultural idiosyncrasies are, theunderlying consistency of experience across time and cultures speaks to theuniversality of anxiety as a human trait. Even filtered through the distinctivecultural practices and beliefs of the Greenland Inuit a hundred years ago, thesyndrome the Inuit called "kayak angst" (those afflicted by it were afraid to goout seal hunting alone) appears to be little different from what we today callagoraphobia. In Hippocrates's ancient writings can be found clinicaldescriptions of pathological anxiety that sound quite modern. One of hispatients was terrified of cats (simple phobia, which today would be coded 300.29for insurance purposes, according to the classifications of the fifth edition ofthe Diagnostic and Statistical Manual, the DSM-V) and another ofnightfall; a third, Hippocrates reported, was "beset by terror" whenever heheard a flute; a fourth could not walk alongside "even the shallowest ditch,"though he had no problem walking inside the ditch — evidence ofwhat we would today call acrophobia, the fear of heights. Hippocrates alsodescribes a patient suffering what would likely be called, in modern diagnosticterminology, panic disorder with agoraphobia (DSM-V code 300.22): thecondition, as Hippocrates described it, "usually attacks abroad, if a person istravelling a lonely road somewhere, and fear seizes him." The syndromesdescribed by Hippocrates are recognizably the same clinical phenomena describedin the latest issues of the Archives of General Psychiatry andBulletin of the Menninger Clinic.
Their similarities bridge the yawning gap of millennia and circumstances thatseparate them, providing a sense of how, for all the differences in culture andsetting, the physiologically anxious aspects of human experience may beuniversal.
In this book, I have set out to explore the "riddle" of anxiety. I am not adoctor, a psychologist, a sociologist, or a historian of science — any oneof whom would bring more scholarly authority to a treatise on anxiety than I do.This is a work of synthesis and reportage, yoking together explorations of theidea of anxiety from history, literature, philosophy, religion, popular culture,and the latest scientific research — all of that woven through somethingabout which I can, alas, claim extensive expertise: my own experience withanxiety. Examining the depths of my own neuroses may seem the height ofnarcissism (and studies do show that self-preoccupation tends to be tied toanxiety), but it's an exercise with worthy antecedents. In 1621, the Oxfordscholar Robert Burton published his canonical The Anatomy of Melancholy,a staggering thirteen-hundred-page work of synthesis, whose torrents ofscholarly exegesis only partially obscure what it really is: a massive litany ofanxious, depressive complaint. In 1733, George Cheyne, a prominent Londonphysician and one of the most influential psychological thinkers of theeighteenth century, published The English Malady, which includes theforty-page chapter "The Case of the Author" (dedicated to "my fellowsufferers"), in which he reports in minute detail on his neuroses (including"Fright, Anxiety, Dread, and Terror" and "a melancholy Fright and Panick, wheremy Reason was of no Use to me") and physical symptoms (including "a suddenviolent Head-ach," "extream Sickness in my Stomach," and "a constant Colick, andan ill Taste and Savour in my Mouth") over the years. More recently, theintellectual odysseys of Charles Darwin, Sigmund Freud, and William James werepowerfully driven by their curiosity about, and the desire to find relief from,their own anxious suffering. Freud used his acute train phobia and hishypochondria, among other things, to construct his theory of psychoanalysis;Darwin was effectively housebound by stress-related illnesses after the voyageof the Beagle — he spent years in pursuit of relief from hisanxiety, visiting spas and, on the advice of one doctor, encasing himself inice. James tried to keep his phobias hidden from the public but was oftenquietly terrified. "I awoke morning after morning with a horrible dread in thepit of my stomach and with a sense of insecurity of life that I never knewbefore," he wrote in 1902 of the onset of his anxiety. "For months, I was unableto go out in the dark alone."
Unlike Darwin, Freud, and James, I'm not out to adumbrate a whole new theory ofmind or of human nature. Rather, this book is motivated by a quest tounderstand, and to find relief from or redemption in, anxious suffering. Thisquest has taken me both backward, into history, and forward, to the frontiers ofmodern scientific research. I have spent much of the past eight years readingthrough hundreds of thousands of the pages that have been written about anxietyover the last three thousand years.
My life has, thankfully, lacked great tragedy or melodrama. I haven't served anyjail time. I haven't been to rehab. I haven't assaulted anyone or carried out asuicide attempt. I haven't woken up naked in the middle of a field, sojourned ina crack house, or been fired from a job for erratic behavior. Aspsychopathologies go, mine has been — so far, most of the time, to outwardappearances — quiet. Robert Downey Jr. will not be starring in the movieof my life. I am, as they say in the clinical literature, "high functioning" forsomeone with an anxiety disorder or a mental illness; I'm usually quite good athiding it. More than a few people, some of whom think they know me quite well,have remarked that they are struck that I, who can seem so even-keeled andimperturbable, would choose to write a book about anxiety. I smile gently whilechurning inside and thinking about what I've learned is a signaturecharacteristic of the phobic personality: "the need and ability" — asdescribed in the self-help book Your Phobia — "to present arelatively placid, untroubled appearance to others, while suffering extremedistress on the inside."
To some people, I may seem calm. But if you could peer beneath the surface, youwould see that I'm like a duck — paddling, paddling, paddling.
Excerpted from My Age of Anxiety by Scott Stossel. Copyright © 2013 Scott Stossel. Excerpted by permission of Random House LLC, a division of Random House, Inc.
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