The Impossible Affliction

My Age of Anxiety: Fear, Hope, Dread, and the Search for Peace of Mind

By Scott StosselKnopf, 2014An estimated forty million Americans currently suffer from a clinical anxiety disorder, but not many suffer the way Scott Stossel suffers. From childhood, he has endured countless varieties of anxiety, worries, and phobias. His “what I’ve tried” list includes nine types of therapy, twenty-eight types of medication, and six types of alcohol. His “what’s worked” list consists of “nothing. Actually, that’s not true. Some drugs have helped a little, for finite periods of time.” So, after exhausting almost every available resource, and reasoning that keeping his anxiety secret all these years hasn’t helped much, he figures there’s nothing left to do but write.The result is My Age of Anxiety, an encyclopedic miscellany of historical, sociological, philosophical, psychological, medical, and, most impressively, personal perspectives on the “riddle” of anxiety as both a universal condition and an individual dilemma. Encouraged by his therapist, Dr. W., of “the possibility that revealing my anxiety will lift the burden of shame and reduce the isolation of solitary suffering,” Stossel, editor of The Atlantic and author of Sarge: The Life and Times of Sargent Shriver, has gone all in, utilizing a mix of elaborate confession, determined engagement, and fanatical scrutiny to recount his lifelong attempts to navigate the vagaries of treatment theory and the psychopharmaceutical industrial complex. By turns engaging and exasperating, it’s the account of a distressed man’s search, fraught with ignominy, frustration, and bewilderment, for some measure of relief.For Stossel, psychological ailments are a family legacy. His great-grandfather was institutionalized for acute anxiety, found some respite with medication and electric shock treatments, and spent the last decades of his life often “reduced to a fetal ball” emitting “inhuman-sounding moaning.” Stossel’s grandfather had obsessive-compulsive disorder, his mother a plethora of neuroses and phobias, his sister and cousins afflictions that have necessitated dependencies on antidepressants and antianxiety medication. And in the “separate compliment of psychopathology,” his father (who referred to young Scott’s therapy appointments as “wacko lessons”) “drank himself into unconsciousness five nights out of seven throughout much of my later childhood.”Stossel’s investigation takes him through every possible source of his anguish, from genetics, this “mixture of Jewish and WASP pathology-a neurotic Jew suppressed inside a neurotic and repressed WASP,” to factors of environment, history, and culture. As his research bears out, every age is an age of anxiety, but it wasn’t until the twentieth century that anxiety became diagnosable, with societal perceptions shifting to augment questions of character and fortitude with ones about neurotransmitters. And it’s in Stossel’s counterbalance of questions like

Why did the ancient Greeks of the Hippocratic school see anxiety mainly as a medical condition, while the Enlightenment philosophers saw it as an intellectual problem? Why did the early existentialists see anxiety as a spiritual condition, while Gilded Age doctors saw it as a specifically Anglo-Saxon stress response—a response that they believed spared Catholic societies—to the Industrial Revolution? Why did the early Freudians see anxiety as a psychological condition emanating from a medical and neurochemical condition, a problem of malfunctioning biomechanics?

with his inherent narcissism—

Was my panic so obvious that the other passengers would see it? Logically, one anxiety should have canceled out the other: if we were all going to die, I shouldn’t have been worried about an ephemeral moment of earthly embarrassment before plunging into the oblivion of eternity, right? On the other hand, if I was going to end up embarrassed after the flight, that would mean we weren’t going to die, right?

—and pertinent concerns about what the self is when you’re “a living repository of the pharmacological trends in anxiety treatment of the last half century”—

What is this long-term reliance on benzodiazepines doing to my brain? Were the emotional anxiety and physical misery I felt after going off the Paxil really the effect of chemical withdrawal? Or was this simply what it feels like to be me undrugged?

—that saves his tale from the self-exploitation that it often threatens to become.Stossel’s struggles are so incessant and severe that readers without a point of reference might have to readjust their sense of plausible behavior to absorb the glut of torments. Take his fear of vomiting: “Emetophobia has governed my life,” he writes, noting that it’s been “thirty-five years, two months, four days, twenty-two hours, and forty-nine minutes” since he has last vomited, and has “spent, by rough calculation, at least 60 percent of my waking life thinking about and worrying about something that I have spent 0 percent of the last three-plus decades doing. This is irrational.”That last line, which applies to most of Stossel’s fears, may be the greatest understatement in contemporary literature. One of the book’s strongest themes is how one makes a life trying to bridge the divide between comprehension and capability, and Stossel is frank, as with all things, about his inability to be rational and about the strategies he utilizes to compensate and assuage. Most prevalent are “extreme” precautions, such as “stashing motion sickness bags, purloined from airplanes, all over my home and office and car in case I’m suddenly overtaken by the need to vomit,” and an almost Rain Man-like reliance on calculation and statistics:

Like a general monitoring the enemy’s advance, I keep a detailed mental map of recorded incidences of norovirus (the most common strain of vomit-inducing stomach virus) and other forms of gastroenteritis, using the Internet to track outbreaks in the United States and around the world. Such is the nature of my obsession that I can tell you at any given moment exactly which nursing homes in New Zealand, cruise ships in the Mediterranean, and elementary schools in Virginia are contending with outbreaks. Once, when I was lamenting to my father that there is no central clearinghouse for information about norovirus outbreaks the way there is for influenza, my wife interjected, ‘Yes, there is,’ she said. We looked at her quizzically. ‘You,’ she said, and she had a point.

It quickly becomes clear that Stossel’s wife must have the compassion of Buddha, especially when one imagines the undisclosed trials that accompany Stossel’s “burdensome overreliance” on her. Among other things, “Dr. W. has diagnosed me with dependent personality disorder, which is, according to the DSM-IV, characterized by excessive psychological dependence on other people (most often a loved one or caretaker) and the belief that one is inadequate and helpless to cope on one’s own.” Which accounts for both a great deal of this narrative’s poignancy, and the quirks that mar it.As shown, Stossel has an inordinate fondness for posing questions, as if after so many years of reliance on therapists he can’t express himself unless prodded by an interrogative. He quotes celebrated minds ranging from Plato to Tony Soprano, needlessly and disruptively, to justify his serious consideration of curious events (although Montaigne’s “The sphincter which serves to discharge our stomachs has dilations and contraction proper to itself, independent of our wishes, and even opposed to them”, is a notable harbinger). And most tiresome are his habitual returns to Dr. W., a Tuesdays with Morrie for the neurotic set that provides Stossel with the reassurance that he is indeed worthy of this endeavor, and the reader with a professional guarantee that anxiety is a predicament far more complex than self-obsession enhanced by an overactive imagination.It’s painful to watch this authoritative writer appear so desperate for validation, but Stossel is blatant about his need to “draw solace” wherever he can find it, not least from stories about “successful and exalted people” who’ve had even tenuously similar debilitations. There’s Charles Darwin’s “stretches where he would vomit multiple times daily and be bedridden for weeks—or, in several cases, years—on end,” Richard Burton’s fear of honey, the crippling stage fright of name performers (Laurence Olivier, Barbra Streisand, Carly Simon, Donny Osmond, Hugh Grant), brilliant athletes who have choked at crucial moments (Greg Norman, Jana Novotna, Roberto Duran), and in the case of basketball legend Bill Russell, the utterly superfluous notation that, “According to one tabulation, Russell vomited before 1,128 of his games between 1956 and 1969, which would put him in Charles Darwin territory.”These strained connections with the famous give the sense not so much of Stossel looking for insight, as of him trying to form a psychoanalytic version of a fantasy football league. Yet, it’s difficult to begrudge him his eccentric comforts, especially when we’re constantly reminded of the sanctioned humiliations foisted on him by the medical establishment. Typical is the situation proposed by Dr. M., one of his former therapists, in which Stossel is pushed to confront his emetophobia by way of exposure therapy:

I’m giving a speech about the founding of the Peace Corps-which feels a little artificial and awkward to begin with, because the venue is a small conference room off a hallway in the Center for Anxiety and Related Disorders. My audience consists of Dr. M. and three graduate students she’s corralled at a moment’s notice from around the building. Meanwhile, in the corner of the room, a large television is showing a video loop of a series of people throwing up.‘Originally, President Kennedy’s plan was to house the Peace Corps inside the Agency for International Development,’ I’m saying as a man on the screen to my right retches loudly. ‘But Lyndon Johnson had been convinced by Kennedy’s brother-in-law Sargent Shriver that stuffing the Peace Corps inside an existing government bureaucracy would stifle its effectiveness and end up neutering it.’ On the screen, vomit spatters onto the floor.A device attached to my finger is monitoring my heart rate and levels of blood oxygen. Every few minutes, Dr. M. Interrupts my speech to say: ‘Give me your anxiety rating now.’ I’m to respond by giving her an assessment of my anxiety at the moment on a scale of 1 to 10, with 1 being completely calm and 10 being unalloyed terror. ‘About a six,’ I say truthfully. I’m less anxious than embarrassed and grossed out.

“As bizarre as this scene was,” he concludes, “the therapeutic principles underlying it are well established.”Still, it’s difficult to forgive Stossel some indulgences, most notably a section on Irritable Bowel Syndrome, a tour de force of unwelcome intimacies and certainly the ne plus ultra of another mysterious affliction, the middle-aged man’s need to expound on the particulars of his regularity. For those unfamiliar with IBS (surely one of the most appreciated acronyms in our language), here’s how it works:

Being anxious makes my stomach hurt and my bowels loosen. My stomach hurting and my bowels loosening makes me even more anxious, which makes my stomach hurt more and my bowels even looser, and so nearly every trip of any insignificant distance from home ends up the same way: with me scurrying frantically from restroom to restroom on a kind of grand tour of the local latrines.

One such expedition takes place in Eastern Europe while visiting a girlfriend, who

had been there for six months by the time I visited; I had planned and aborted (because of anxiety) several previous trips, and only the fear that Ann would finally break up with me if I didn’t visit her impelled me to fight through my tremendous dread of a transatlantic flight to meet her in Warsaw. Drugged to near unconsciousness, I flew from Boston to London and then to Warsaw. Befogged by sedatives, antiemetic medications, and jet lag, I stumbled through our first day and a half together. My bowels percolated to life about the time the rest of me did, when the Dramamine and Xanax wore off. We ended up traipsing around Eastern Europe from restroom to restroom. This was frustrating for her and harrowing for me – because, among other reasons, many Eastern European public commodes were at that time rather primitive; you often had to pay an attendant in advance on a per sheet basis for scratchy, ill-constructed toilet paper. By the end of the trip, I’d given up; Ann went sightseeing while I retreated to our hotel room, where at least I didn’t have to gauge my toilet tissue use in advance.

Those curious about subjects such as the relation between mental distress and gastric secretions, the results of balloon inflation in the colons of test subjects, or the poetic delicacy brought to such matters during the Middle Ages (“windy melancholy” makes rank expulsion sound almost soulful), are invited to peruse this section at their leisure. And it is worth wading through, as it were, for a hilarious story about Stossel at the Kennedy compound when Bill Clinton was a guest, with Stossel seeking a place to relieve himself, a frantic attempt to stop a leaking toilet, subsequent sewage wrangling, a pants-less encounter with John F. Kennedy, Jr., and Stossel eluding Secret Service agents during a night mission to throw away the bathroom rug and towels he had used trying to sop up the mess. However, readers who hold the opinion that a little watery stool goes a long way might get to the part where Stossel makes it to a toilet, declares, “My relief was extravagant and almost metaphysical,” and anticipate feeling the same way about reaching the memoir’s last page. Stossel’s exorbitance about topics like this makes you understand why most men lead lives of quiet desperation – it’s a courtesy.But in this lack of restraint is also the book’s strange triumph: it is the most accurate representation of the anxiety sufferer’s mindset that I’ve ever come across. As Stossel makes evident, the experience of anxiety can be so immoderate as to ruin one’s sense of moderation in general, especially when empowered with the preface, “My therapist says….” The form of the book, with its multitude of personal tensions, captures the endless, frantic scramble for equilibrium between the alternating pulls of self-obsession and self-negation, retreat into and resistance against established comforts, and the need for independent action impeded, always, by the ferocious undertow of constraint imposed by uncontrollable psychological forces.I suspect that much will be made of Stossel’s bravery, but praise should be given to his literary achievement and the arrival of a substantial, if challenging, voice capable of elucidating the 130 year history of “magic” pharmaceuticals from cocaine to Xanax, the mess of conundrums that have accompanied “a culturally ascendant new idea—that mental illness was caused not by bad parenting or unresolved Oedipus complexes but by biological imbalances, organic disturbances in the brain that could be corrected with chemical interventions”, and savvy enough to conclude with, “the irony of what I have had to ingest in order to write this section on drugs is obvious.” Perhaps only a fellow sufferer will truly understand what it is to live with fear and discomforts so ceaseless as to make one genuinely wish for death so that they just finally end, or for Stossel to have attained all that he has while contending with a malady that can turn a walk to the grocery store into a Homeric ordeal. But one doesn’t need to be a fellow traveler to admire how Stossel, despite his concern that “this book, with its revelations of anxiety and struggle, will be a litany of Too Much Information, a violation of basic restraint and decorum,” risked considerable embarrassment to emerge with penetrating insights about both the efficacy of the examined life and the limits of self-awareness. For these reasons, the book is a startling achievement, especially when Stossel frees himself from the need to please his masters, and when we consider that the specificity of this story lies in the need to substantiate a life that often seems like little more than a man at the mercy of his digestive system.Stossel concludes his journey by returning to a last possible source, his first therapist, Dr. L., whom he had seen as a boy. During the course of a resigned and moving interview, Stossel asks,

“Am I doomed by my neurocircuitry? I went to therapy with you for twenty-five years, and have seen multiple other therapists, and have tried multiple methods of treatment. And yet here I am, advancing into middle age, and still suffering from chronic and often debilitating anxiety.”“No, you’re not doomed,” Dr. L. said. “We now know enough about neuroplasticity to understand that the circuitry is always growing. You can always modify the software.”

It’s unfortunate that, having proved repeatedly that he can speak for himself, Stossel allows someone else to offer the obvious conclusion: that the specifics of each individual define their disease. Stossel states a hope that this book may provide solace to others, but the only real consolation here is the evidence that whatever your state, it can always be worse. We’re left with the sense that information has been heaped atop information just to reinforce how inconclusive it all is, and that perhaps the only crucial riddle about anxiety, whatever that means, exactly, is how each individual can pursue an effective management of a disorder still largely beyond reason.After finishing this often grueling book, I found that one of those intrusive quotes resonated. Boxing manager Cus D’Amato, who knew more about human foibles than many referenced herein, is quoted as saying, “The hero and the coward both feel the same thing, but the hero uses his fear, projects it onto his opponent, while the coward runs. It’s the same thing, fear, but it’s what you do with it that matters.” And with the strange sympathy generated for Stossel, whose fight to save himself exists beyond traditional notions of bravery and masculinity, it’s tempting to view his returns to Dr. W. as a boxer going back to his corner, to be tended to, admonished and inspired, then sent back out for another round in an endless battle with an indefatigable opponent. A bit sentimental maybe. But perhaps only fellow sufferers will understand the occasional need for that as well.____Steve Danziger is managing editor of Fiction magazine and a contributing editor at Open Letters.adapted from a photo by Jean-Pol GRANDMONT