More On Anxiety....

An excerpt from an article in the Atlantic Monthly [I thank D.R. for bringing it to my attention]. I have what to say - but in the meantime I will let the article speak for itself. We all either suffer from extreme anxiety or know people who do.

          
I’ve finally settled on a pre-talk regimen that enables me to avoid the weeks of anticipatory misery that the approach of a public-speaking engagement would otherwise produce.
Let’s say you’re sitting in an audience and I’m at the lectern. Here’s what I’ve likely done to prepare. Four hours or so ago, I took my first half milligram of Xanax. (I’ve learned that if I wait too long to take it, my fight-or-flight response kicks so far into overdrive that medication is not enough to yank it back.) Then, about an hour ago, I took my second half milligram of Xanax and perhaps 20 milligrams of Inderal. (I need the whole milligram of Xanax plus the Inderal, which is a blood-pressure medication, or beta-blocker, that dampens the response of the sympathetic nervous system, to keep my physiological responses to the anxious stimulus of standing in front of you—the sweating, trembling, nausea, burping, stomach cramps, and constriction in my throat and chest—from overwhelming me.) I likely washed those pills down with a shot of scotch or, more likely, vodka, the odor of which is less detectable on my breath. Even two Xanax and an Inderal are not enough to calm my racing thoughts and to keep my chest and throat from constricting to the point where I cannot speak; I need the alcohol to slow things down and to subdue the residual physiological eruptions that the drugs are inadequate to contain. In fact, I probably drank my second shot—yes, even though I might be speaking to you at, say, 9 in the morning—between 15 and 30 minutes ago, assuming the pre-talk proceedings allowed me a moment to sneak away for a quaff.

I wish I could say that my anxiety is a recent development, or that it is limited to public speaking. It’s not. My wedding was accompanied by sweating so torrential that it soaked through my clothes and by shakes so severe that I had to lean on my bride at the altar, so as not to collapse. At the birth of our first child, the nurses had to briefly stop ministering to my wife, who was in the throes of labor, to attend to me as I turned pale and keeled over. I’ve abandoned dates; walked out of exams; and had breakdowns during job interviews, plane flights, train trips, and car rides, and simply walking down the street. On ordinary days, doing ordinary things—reading a book, lying in bed, talking on the phone, sitting in a meeting, playing tennis—I have thousands of times been stricken by a pervasive sense of existential dread and been beset by nausea, vertigo, shaking, and a panoply of other physical symptoms. In these instances, I have sometimes been convinced that death, or something somehow worse, was imminent.

Even when not actively afflicted by such acute episodes, I am buffeted by worry: about my health and my family members’ health; about finances; about work; about the rattle in my car and the dripping in my basement; about the encroachment of old age and the inevitability of death; about everything and nothing. Sometimes this worry gets transmuted into low-grade physical discomfort—stomachaches, headaches, dizziness, pains in my arms and legs—or a general malaise, as though I have mononucleosis or the flu. At various times, I have developed anxiety-induced difficulties breathing, swallowing, even walking; these difficulties then become obsessions, consuming all of my thinking.

Anxiety has afflicted me all my life. When I was a child and my mother was attending law school at night, I spent evenings at home with a babysitter, abjectly terrified that my parents had died in a car crash or had abandoned me (the clinical term for this is separation anxiety); by age 7 I had worn grooves in the carpet of my bedroom with my relentless pacing, trying to will my parents to come home. During first grade, I spent nearly every afternoon for months in the school nurse’s office, sick with psychosomatic headaches, begging to go home; by third grade, stomachaches had replaced the headaches, but my daily trudge to the infirmary remained the same. During high school, I would purposely lose tennis and squash matches to escape the agony of anxiety that competitive situations would provoke in me.

In short, I have, since the age of about 2, been a twitchy bundle of phobias, fears, and neuroses. And I have, since the age of 10, when I was first taken to a mental hospital for evaluation and then referred to a psychiatrist for treatment, tried in various ways to overcome my anxiety.
Here’s what I’ve tried: individual psychotherapy (three decades of it), family therapy, group therapy, cognitive-behavioral therapy, rational emotive behavior therapy, acceptance and commitment therapy, hypnosis, meditation, role-playing, interoceptive exposure therapy, in vivo exposure therapy, self-help workbooks, massage therapy, prayer, acupuncture, yoga, Stoic philosophy, and audiotapes I ordered off a late-night TV infomercial.

And medication. Lots of medication. Thorazine. Imipramine. Desipramine. Chlorpheniramine. Nardil. BuSpar. Prozac. Zoloft. Paxil. Wellbutrin. Effexor. Celexa. Lexapro. Cymbalta. Luvox. Trazodone. Levoxyl. Inderal. Tranxene. Serax. Centrax. St. John’s wort. Zolpidem. Valium. Librium. Ativan. Xanax. Klonopin.

Also: beer, wine, gin, bourbon, vodka, and scotch.

Here’s what’s worked: nothing.

My general condition is hardly unique. Anxiety and its associated disorders represent the most common form of officially classified mental illness in the United States today, more common even than depression and other mood disorders. According to the National Institute of Mental Health, some 40 million American adults, about one in six, are suffering from some kind of anxiety disorder at any given time; based on the most recent data from the Department of Health and Human Services, their treatment accounts for more than a quarter of all spending on mental-health care. Recent epidemiological data suggest that one in four of us can expect to be stricken by debilitating anxiety at some point in our lifetime. And it is debilitating: studies have compared the psychic and physical impairment tied to living with an anxiety disorder with the impairment tied to living with diabetes—both conditions are usually manageable, sometimes fatal, and always a pain to deal with.

Is pathological anxiety a medical illness, as Hippocrates and Aristotle and many modern psychopharmacologists would have it? Or is it a philosophical problem, as Plato and Spinoza and the cognitive-behavioral therapists would have it? Is it a psychological problem, a product of childhood trauma and sexual inhibition, as Freud and his acolytes once had it? Or is it a spiritual condition, as Søren Kierkegaard and his existentialist descendants claimed? Or, finally, is it—as W. H. Auden and David Riesman and Erich Fromm and Albert Camus and scores of modern commentators have declared—a cultural condition, a function of the times we live in and the structure of our society?
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 seem to have a simple, single source—a bad gene, say, or a childhood trauma—may not. After all, who’s to say that Spinoza’s vaunted equanimity, though ostensibly a result of his philosophy of applying logical reasoning to irrational fear, wasn’t in fact a product of his biology? Mightn’t a genetically programmed low level of autonomic arousal have produced his serene philosophy, rather than the other way around?

....... Or do the roots of my anxiety lie even deeper and extend more broadly than the things I’ve experienced and the genes I’ve inherited—that is, in history and in culture? My father’s parents were Jews who emigrated from Weimar Germany. My father’s mother became a nastily anti-Semitic Jew—she renounced her Jewishness out of fear that she would someday be persecuted for it. My sister and I were raised in the Episcopal Church, our Jewish background hidden from us until I was in high school. My father, for his part, has had a lifelong fascination with World War II, and specifically with the Nazis; he watched the 1973–74 television series The World at War again and again. In my memory, that program, with its stentorian music accompanying the Nazi advance on Paris, is the running soundtrack to my early childhood. Jews, of course, have millennia of experience in having reason to be scared—which perhaps explains why some studies have suggested that Jewish men are more likely to suffer from neuroses than are men in other groups.

My mother’s cultural heritage, on the other hand, is heavily WASP; she is a proud Mayflower descendant who until recently subscribed to the notion that there is no emotion and no family issue that should not be suppressed.

Thus, me: a mixture of Jewish and WASP pathology—a neurotic and histrionic Jew suppressed inside a neurotic and repressed WASP. No wonder I’m anxious: I’m like Woody Allen trapped inside John Calvin.