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Now the 诪讻讛!
Wall Street Journal
A medical advisory group to the federal government has just recommended that all adult Americans age 19 to 64 be screened for anxiety. Earlier this year, the U.S. Preventive Services Task Force—which advises both the Department of Health and Human Services and Congress—recommended anxiety screening for children 8 to 18.
One could see this coming: The ultimate pandemic is now life itself. It’s hard to know whether the recommendation of mass anxiety screening should be met with satire or chagrin.
What took them so long? The idea that we live in an Age of Anxiety has been common at least since W.H. Auden’s book-length poem with that title appeared in 1947. In 1993 the psychiatrist Peter Kramer produced a best-selling book, “Listening to Prozac,” a meditation on the implications of the quickly adopted antidepressant drug approved in 1987.
The task force’s recommendation that virtually all adults be screened for anxiety will be significant if support builds for its adoption as standard care. That would move what most people consider a recurring condition of life—such as happiness or sadness—closer to something that would be submissible for control by formal institutions, including the state. The question is: Will this make us better or worse?
Much of the public isn’t in the mood for public-health interventions. The Covid-19 pandemic is winding down amid a broad reckoning about the restrictive policy recommendations scientific authorities made and imposed on the public. This striking headline appeared recently in the publication Education Week: “The Pandemic Was a ‘Wrecking Ball’ for K-12, and We’re Still Tallying the Damage.” Including anxiety.
So skepticism is inevitable when an arm of the science-policy community emerges at the pandemic’s end to say all children and adults (but not adults over 65) should somehow be screened for anxiety disorders. It’s already clear that a post-Covid care industry is emerging. Anxiety mitigation would provide lifetime work in schools, medicine and the media.
By the way, before the task force publishes the final version of its anxiety recommendations, the document will be available for public comment on the organization’s website until Oct. 17.
To be clear, these recommendations are only indirectly about the disease of depression. They focus explicitly on generalized anxiety disorder, social anxiety disorder, panic disorder, separation anxiety disorder and phobias.
Unmistakably, anxiety can become a pathway to disabling and destructive ailments. Moreover, the task force’s draft statement itself is refreshingly modest in its assertions of what science knows about anxiety or could achieve with mass screening. The panel “concludes with moderate certainty that screening for anxiety in adults, including pregnant and postpartum persons, has a moderate net benefit.”
As to therapies and treatments, psychological intervention produces “a small but statistically significant reduction” in anxiety symptoms. Psychopharmacologic drugs—mainly antidepressants and benzodiazepines—benefit some people. But that raises an age-old question similar to administering drugs for ostensibly hyperactive boys in grade school: Would anxiety screening put many more millions on a lifetime regimen of pharmaceuticals?
Unaddressed is how many primary-care docs will want to add formalized anxiety tests to what hospital systems or insurers already ask them to do. One task-force member, Dr. Lori Pbert, did address that for the New York Times, suggesting providers should “do what they already do on a daily basis: juggle and prioritize.” Perhaps the panel should next propose anxiety screening for doctors and nurses.
The first adopters are likely to be K-12 public schools, whose teachers unions would cheerfully add anxiety screeners to their expanding categories of membership. By the way, the task force notes that a positive screen for anxiety would then require a fuller, confirming diagnosis. The screenings themselves, especially in schools, could become a source of dread.
Yes of course the recommendation includes comments about race, wealth inequities, etc. And the panel exempts the 65+ population, not because their lives are more settled by then but because some symptoms of anxiety, such as sleeplessness or pain, overlap with the “natural signs of aging.”
This looks like a tide impossible to resist. We saw a great shift occurring away from calmer, more outward-looking lives toward predominantly self-directed obsessions when campuses created “safe spaces” for students who couldn’t cope. The Preventive Services Task Force provides 30 footnotes of research behind its recommendations but makes no attempt to explain how we arrived at a state of mass anxiety or what did this to us. The words “social media” and “web” appear nowhere, suggesting that for these doctors the only clinically relevant issue now is how to treat this universal malady.
Still, it’s sad to think that if we are helpless before the relentless salami slicer of daily life, mass psychological disorder is to be the unavoidable norm. One sure thing: Sellers of solutions will surf the anxiety wave. Mark Zuckerberg renamed Facebook as Meta because he believes the future will consist of people by the millions strapping on headsets to inhabit whatever me-only metaverse they wish to live in. Don’t laugh. He’s done OK already with one dystopia.
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