Anxiety is normal, but too much can be crippling. An author and anxiety sufferer discusses the nature of crippling anxiety and what people can do about it.
- Scott Stossel, editor, Atlantic magazine and author, My Age of Anxiety: Fear, Hope, Dread and the Search for Peace of Mind
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Nancy Benson: Anxiety is something we all feel now and then, it’s a natural evolutionary trait – part of the fight or flight response that’s helped humans survive for millennia. Today we’re not running away from saber tooth tigers but it’s still natural to feel anxiety under stress. Like before taking a test for example or asking your boss for a raise. However for some people anxiety is of the charts overwhelming and debilitating even when there’s not apparent threat.
Scott Stossel: People who have really severe anxiety disorders, suffer from clinical anxiety really badly, there’s some that have not been able to leave their house for years at a time, or are unable to travel, or are unable if they have severe social anxiety to hold jobs and be in relationships just because the mere act of interacting with other people becomes so anxiety producing.
Benson: That’s Scott Stossel, Editor of the Atlantic Magazine and author of ‘My Age of Anxiety: Fear, Hope, Dread and the Search of Peace of Mind.” Stossel has suffered from severe anxiety ever since he was a kid, that’s when most acute anxiety disorders take root.
Stossel: When I was a kid any time I was away from my parents I would be convinced that they had abandoned me or had died in a car crash and I literally paced through the carpet in my bedroom because even if they were late, 10 minutes late to when they were supposed to be home, I would be absolutely convinced that I was never going to see them again. As I’ve gotten older you know, my sort of first and still most long standing phobia is a emetophobia, which sounds even more idiosyncratic and weird to people who’ve never heard of it or never had it but many people do and are now learning from internet research that emetophobia is the pathological fear of vomiting. So you know, when I was a kid or even as an adult and exposed to someone who’s sick I end up impulsively washing my hands, I would leave the house if someone in the house was sick, I would spend much of my time non productively analyzing how to avoid contracting stomach virus.’
Benson: Stossel also has claustrophobia; a fear of enclosed spaces. He’s also afraid of heights, cheese, fainting, flying in an airplane, germs, and speaking in public.
Stossel: Sometimes it can be what they call “endogenous panic attacks” and they can strike just from nowhere, when suddenly you feel this intense overwhelming dread and terror but physiologically it’s like your body is going to meltdown. People often think they’re dying and turn up at emergency rooms because they’re having a heart attach because you begin sweating, you get dizzy, you feel nauseous, you have other gastric distress, you start shaking and trembling, you get tingling in your hands and your feet, it’s sort of accompanied with overwhelming sense of dread and a kind of need to escape and I’ve had that happen to me thousands of times over the course of my lifetime. And unfortunately some of the times it happens at work and I have to kind of run and hide in a stairwell or something like that.
Benson: Researchers don’t know whether clinical anxiety is an emotional, chemical, psychological, or spiritual problem. Stossel says it’s probably all of the above.
Stossel: Once one or more members of a family tree have ‘Generalized Anxiety Disorder’ or some other form of anxiety, it’s a much much more likely that many other members of that family tree will also develop it and they’ve now even begun to isolate some of the constellations of genes that lead to anxious temperaments; so probably it is genetic.
Benson: Clinical anxiety has been documented in the annals of history from Hippocrates and Plato to Darwin and Freud, and every era presumes that it’s the most anxious. But Stossel says people today really are more anxious than ever; we have more potentially paralyzing choices to make in life. Few things are clear-cut even when we go to the grocery store. What we do about debilitating anxiety has changed as well, we still often medicate it – for example Hippocrates suggested drinking wine. In the Victorian age it was laudanum but now we have more choices.
Stossel: These days the main treatments are an array of medications that you can take that treat it at it’s source, sort of in the brain. But the kind of cutting edge psychological treatment kind of therapies, there’s a lot of evidence to support their efficacy are cognitive behavioural therapy, or CBT, which basically involves a sort of exposure therapy which is directly confronting the thing that makes you anxious but in the company of a therapist through guided deep breathing and relaxation and learning that you can confront the thing that scares you without having it overwhelm you. And then reframing – they call it cognitive reframing – how you think about things and that can be very effective. A lot of research shows that it’s as effective as medication but doesn’t have side effects and dependency issues. And mindfulness meditation; there’s all kinds of new evidence that this practice which emerged from the east is not being adapted in the west.
Benson: That’s a long list of possible therapies and Stossel has tried them all.
Stossel: In my own life, I would not have been able to survive and thrive, and be as productive as I have without access to various forms of antidepressants and antianxiety medications and there are many people for whom the difference between being completely debilitated and unable to function, and being able to be out in the world and being productive, is a pill or some combination of pills. So I’m not anti-medication – that said all things being equal, if you can manage your anxiety without medication, you’re better off – because you’re avoiding the risk of side effects and dependency issues and there are probably a lot of people who are getting medication who don’t really need it. Just because it’s easier for physicians to get reimbursed by insurance companies have the same right for doing what they call a “15 minute psychopharmacological consult” rather than a full 15-minute therapeutic hour.
Benson: but whether one is medicated or not the good news is that anxiety levels seem to decrease naturally with age.
Stossel: There’s a lot of research that shows that as you get into your 50’s and middle age, both anxiety and depression tend to decrease for a variety of reasons that researchers theorize either have to do with kind of changing expectations of what you’re going to get out of life and you become more accepting of yourself and maybe actually neurobiological changes to your brain that make you more even keeled than content. So usually getting older relieves anxiety.
Benson: Stossel has also had to take a good long look at his anxiety as well. He says that writing his book has relieved his anxiety levels, at least somewhat.
Stossel: Simply the act of finishing the book and having it come out and the world not end, I sort of wrestle with the shame and stigma of anxiety, that was therapeutic. I also have sort of done exposure therapy and having to do a lot of public speaking and stuff and that, you know I’ve gotten a lot better at managing the medication to do that and just with practice you get better and my overall levels of anxiety is moderately reduced. But is it gone or am I cured? No, I definitely still have bad episodes and you have to resort to medication, but overall the balance has been helpful and I still retain the hope that I’ll continue to improve and maybe someday be largely in remission if not fully cured.
Benson: And it’s also been incredibly gratifying for Stossel to hear from many people who’ve thanked him for bringing the issue of anxiety to light.
Stossel: It’s been quite striking and gratifying to hear from, not only friends and colleagues, but also total strangers and including some celebrities who say, “this is what I suffer from all these years I’m glad to see you articulating from within my own head (and) thank you for talking opening about this – it makes me feel less alone or more comfortable or more comfortable talking about it myself,” including from some psychotherapists who say they have that sort of life long coming to terms with their anxiety and that the reason the book helped them with that process. And I had other friends write to me or talk to me and say, the book made them feel good because they thought “well, I thought I was anxious but at least I’m not as messed up as you” so they felt better (laughs).
Benson: You can learn more about Scott Stossel and find a link to his book, “My Age of Anxiety: Fear, Hope, Dread and the Search for Peace of Mind,” through a link on our website at RadioHealthJournal.net. You can always find our shows on iTunes and Stitcher. Our writer/producer this week is Polly Hansen. Our Production Directors are Sean Waldron and Nick Hofstra. I’m Nancy Benson.